Abnormal Uterine Bleeding: Causes, Diagnosis, and Treatment Methods

Uterine bleeding is one of the most common reasons women visit gynecology clinics worldwide. Any bleeding that occurs outside the regular menstrual cycle, lasts longer than normal, occurs more frequently, or is excessive in volume is defined as Abnormal Uterine Bleeding (AUB).

These irregular or heavy periods do not just disrupt daily life and social activities; they can also be the primary symptom of an underlying gynecological condition that requires medical attention. Therefore, the root causes of uterine bleeding must be thoroughly investigated and evaluated by a specialist. For women and expatriates living in Fethiye, Ortaca, Dalaman, and surrounding coastal areas, consulting a gynecologist when noticing these irregularities is crucial for long-term health.

What is Abnormal Uterine Bleeding (AUB)?

In non-pregnant women, any uterine bleeding that deviates from the normal physiological boundaries in terms of:

• Duration,

• Frequency,

• Regularity, or

• Volume,

is classified as abnormal uterine bleeding. In modern gynecology, specialists utilize the globally recognized PALM-COEIN system to classify the underlying causes of uterine bleeding and to structure a personalized treatment plan.

Causes of Abnormal Uterine Bleeding

The causes of abnormal bleeding are divided into two main categories: structural causes (which can be visually diagnosed via ultrasound or imaging) and non-structural causes.

1. Structural Causes (The PALM Classification)

• Polyps (P): Benign growths on the lining of the uterus (endometrium) or cervix. They frequently cause spotting between periods or bleeding after intercourse.

• Adenomyosis (A): A condition where the tissue that normally lines the uterus grows into the muscular wall of the uterus. It typically causes painful, clotted, and exceptionally heavy periods.

• Leiomyomas / Fibroids (L): Benign uterine tumors. Specifically, submucosal fibroids (which grow into the uterine cavity) are the most common cause of heavy menstrual bleeding and iron-deficiency anemia in women.

• Malignancy & Hyperplasia (M): Pre-cancerous thickening of the uterine lining or uterine cancer. This risk must absolutely be ruled out first, especially in cases of postmenopausal bleeding.

2. Non-Structural Causes (The COEIN Classification)

• Coagulopathy (C): Inherited or acquired blood clotting disorders.

• Ovulatory Dysfunction (O): Irregular or absent ovulation. This is highly prevalent during adolescence (just after the first period) and perimenopause (the transition to menopause).

• Endometrial Causes (E): Primary localized deficiencies in the mechanisms that regulate endometrial bleeding.

• Iatrogenic Causes (I): Bleeding induced by medical treatments, irregular use of hormone therapies, certain birth control methods, or blood thinners.

• Not Yet Classified (N): Rare or poorly defined causes.

Diagnosis and Evaluation of Uterine Bleeding

The first step toward an effective treatment is precisely identifying the source of the bleeding. The typical clinical diagnostic steps include:

• Detailed Patient History: The duration, volume, and frequency of the bleeding, presence of blood clots, pelvic pain, medication history, and chronic diseases are carefully evaluated.

• Gynecological Examination: A physical check of the uterus, cervix, and surrounding pelvic structures.

• Laboratory Tests: A pregnancy test to rule out pregnancy-related bleeding, a complete blood count (CBC) to measure the severity of anemia, and thyroid or coagulation profiles if indicated.

• Pelvic Ultrasound (USG): Transvaginal ultrasound is the primary, most valuable non-invasive tool. In certain cases, a sonohisterography (saline infusion sonography) or pelvic MRI may be requested.

• Endometrial Biopsy (Uterine Sampling): This is highly recommended for all women over the age of 45, younger patients with specific risk factors (such as obesity or PCOS), and patients who do not respond to medical therapies, to screen for endometrial hyperplasia or cancer.

Note for Foreign Residents: For patients residing in quieter coastal areas such as Köyceğiz, Seydikemer, Datça, Kalkan, and Kaş, it is extremely important not to ignore unexpected spotting, particularly after menopause. Scheduling a prompt gynecological check-up for an ultrasound or biopsy is vital.

Treatment Options for Uterine Bleeding

The treatment strategy is entirely personalized and depends on the patient's age, plans for future pregnancy, the severity of the bleeding, and the specific underlying PALM-COEIN cause.

Medical (Non-Surgical) Treatments

Medical management is generally the first line of defense for hormonal imbalances or non-structural causes. Options include oral contraceptive pills, progesterone therapies, tranexamic acid to reduce blood flow, or the insertion of a hormone-releasing intrauterine device (IUD - Mirena), which effectively minimizes heavy bleeding.

Surgical Treatments

Surgery is preferred when medical options fail or when the bleeding is caused by structural issues like fibroids or polyps:

• Hysteroscopy: A minimally invasive, stitchless outpatient procedure where a tiny camera is inserted into the uterus to remove polyps or submucosal fibroids safely.

• Myomectomy: Surgical removal of fibroids via laparoscopic (keyhole) or open surgery, preserving the uterus for future pregnancies.

• Endometrial Ablation: A procedure that thins or destroys the lining of the uterus for patients who have completed childbearing.

• Hysterectomy: The surgical removal of the uterus, reserved for severe, high-risk conditions or when other treatments have proven ineffective.

Professional Gynecological Care in Muğla

Uterine bleeding can stem from wide-ranging factors, but with a modern, evidence-based medical approach, it can be managed successfully. Proper treatment not only eliminates chronic fatigue caused by anemia but significantly restores your daily comfort and quality of life.

We offer international standard gynecological diagnostic and treatment services for women and expatriates living across the Muğla province—including Fethiye, Dalaman, Köyceğiz, Ortaca, Seydikemer, Marmaris, Datça, Kalkan, and Kaş. Our clinic utilizes advanced medical imaging and operates strictly under international clinical guidelines.

Do not delay your gynecological health. For a precise diagnosis and tailored treatment options regarding unexpected vaginal bleeding, please get in touch with our clinic to schedule your private consultation.