Abnormal Uterine Bleeding (AUB)
A Comprehensive Guide to Your Cycle
As a gynaecologist, the most frequent conversation I have with my patients begins with the phrase: "I don’t think my period is normal." This simple observation is often the start of a journey toward significant health improvements. In the medical world, we call this Abnormal Uterine Bleeding (AUB). It is a broad term that covers anything from periods that are too heavy or too long, to spotting between cycles or bleeding after menopause.
For many women, menstrual struggles are dismissed as "just a part of life." I am here to tell you that while your cycle is a vital sign of your health, it should not be a burden that prevents you from living your life fully. If you are planning your social life around your period, avoiding white clothing, or feeling exhausted every month, it is time for you to come see me for a professional evaluation.
What is a "Normal" Period?
To understand what is abnormal, we must first define the baseline. A typical menstrual cycle is measured from the first day of one period to the first day of the next.
Frequency: Usually every 21 to 35 days.
Duration: Bleeding should last between 3 and 7 days.
Volume: The average blood loss is about 30 to 40ml (roughly 2 to 3 tablespoons).
If your cycle falls consistently outside these windows—for example, coming every 15 days or lasting 10 days—it is clinically classified as AUB.
Recognising Heavy Menstrual Bleeding (Menorrhagia)
Many patients find it difficult to quantify their blood loss. After all, you aren’t measuring it in a beaker. However, there are practical signs that your bleeding is excessive (Menorrhagia):
Flooding: Soaking through a high-absorbency pad or tampon every hour for several hours.
Double Protection: Needing to wear a tampon and a pad simultaneously to avoid accidents.
Night Disruptions: Having to wake up in the middle of the night to change sanitary products.
Large Clots: Passing blood clots larger than a 20-cent coin.
Anaemia Symptoms: Feeling breathless, dizzy, or profoundly fatigued during or after your period.
Common Causes: The "PALM-COEIN" Framework
Gynaecologists use a specific framework called PALM-COEIN to categorize the causes of AUB. This helps us determine if the cause is structural (something we can see) or functional (related to how the body works).
Structural Causes (PALM):
Polyps: Small, benign growths in the uterine lining.
Adenomyosis: Where the lining grows into the muscle of the uterus.
Leiomyoma (Fibroids): Non-cancerous muscular growths.
Malignancy: Though rare in younger women, we must always rule out precancerous or cancerous changes.
Functional Causes (COEIN):
Coagulopathy: Bleeding disorders that prevent clotting.
Ovulatory Dysfunction: Common in conditions like PCOS, where the body doesn't release an egg regularly.
Endometrial Issues: Problems with how the uterine lining regulates itself.
Iatrogenic: Bleeding caused by medications, such as blood thinners or certain IUDs.
Not Classified: Rare or specific conditions.
The Diagnostic Path
When you visit my rooms for AUB, our goal is to move from "uncertainty" to a "clear diagnosis." This process is collaborative and thorough:
The Clinical History: We will discuss your cycle history in detail. I recommend using a period-tracking app for 2–3 months prior to our visit if possible.
Blood Investigations: We check your iron levels (ferritin) and hormone profiles (Thyroid, PCOS markers).
Pelvic Ultrasound: This is the primary tool for identifying fibroids, polyps, or signs of adenomyosis.
Hysteroscopy & Biopsy: In some cases, I may recommend a Hysteroscopy/D&C to look inside the uterus and take a sample of the lining to ensure there are no abnormal cells.
Treatment Options: Medical and Surgical
The "best" treatment is the one that aligns with your lifestyle and fertility goals. We have moved far beyond the days when a hysterectomy was the only answer.
Non-Hormonal Options: Medications like Tranexamic acid can reduce flow by helping the blood clot more effectively.
Hormonal Management: The Mirena IUD is a highly effective for reducing heavy bleeding. Oral contraceptive pills or progestogen tablets can also regulate cycles.
Minimally Invasive Surgery: For structural issues, I have the skills and expertise to offer you options including Hysteroscopy Dilatation and Curettage and Polypectomy, Laparoscopic Hysterectomy or Endometrial Ablation for women who have completed their families and want a permanent reduction in flow.
Individualised Care for Your Cycle
I understand that abnormal bleeding is more than just a medical diagnosis; it is a quality-of-life issue that can affect your confidence, your work, and your relationships. As a highly qualified gynaecologist, I am dedicated to listening to your experience and validating your concerns.
My approach is entirely individualised.
I offer a full spectrum of care, from medical management and lifestyle adjustments to advanced, minimally invasive surgical options. Whether we are investigating the cause of your heavy periods or seeking a permanent surgical solution, I am committed to providing expert, evidence-based care in a supportive environment where you feel heard and safe.