Abnormal Uterine Bleeding

Abnormal-Uterine-Bleeding

What Is Abnormal Uterine Bleeding (AUB)?

Abnormal Uterine Bleeding (AUB) refers to any irregularity in a woman’s menstrual cycle regarding frequency, duration, or amount of bleeding.
It includes heavy menstrual bleeding (menorrhagia), prolonged periods, bleeding between periods, or postmenopausal bleeding.

While occasional irregularity may be harmless, persistent or unexplained bleeding often indicates an underlying hormonal, structural, or pathological cause that requires evaluation.

Common Causes of Abnormal Uterine Bleeding

AUB can be classified according to the PALM-COEIN system recommended by the International Federation of Gynecology and Obstetrics (FIGO):

Structural Causes (PALM):

  • P – Polyps: Benign growths of the uterine lining
  • A – Adenomyosis: Endometrial tissue growing into the uterine wall
  • L – Leiomyoma (Fibroids): Benign muscular tumors of the uterus
  • M – Malignancy/Hyperplasia: Precancerous or cancerous endometrial changes

Non-Structural Causes (COEIN):

  • C – Coagulopathy: Blood clotting disorders
  • O – Ovulatory Dysfunction: Hormonal imbalance (common in PCOS, perimenopause)
  • E – Endometrial Dysfunction: Abnormal response of the uterine lining
  • I – Iatrogenic: Caused by medications or intrauterine devices (IUDs)
  • N – Not Otherwise Classified: Rare or mixed causes

Symptoms That Require Evaluation

  • Heavy bleeding soaking pads/tampons every hour
  • Menstrual cycles shorter than 21 or longer than 35 days
  • Spotting or bleeding between periods
  • Postcoital or postmenopausal bleeding
  • Fatigue, anemia, or dizziness related to blood loss

If these symptoms persist, timely evaluation is essential to rule out serious conditions such as endometrial hyperplasia or cancer.

Diagnostic Approach at Saga Clinic

Dr. Eser Agar follows a structured and comprehensive protocol for evaluating abnormal bleeding:

1. Detailed Medical History and Physical Examination

Includes assessment of menstrual pattern, contraceptive use, medications, and family history.

2. Transvaginal Ultrasound

Provides detailed visualization of the uterus, endometrium, ovaries, and any structural abnormalities like fibroids or polyps.

3. Endometrial Biopsy or Pipelle Sampling

Performed in-office to assess endometrial health and rule out hyperplasia or malignancy.

4. Hysteroscopy

Offers direct visualization of the uterine cavity and allows targeted treatment of intrauterine pathology (e.g., removal of polyps or small fibroids).

5. Hormonal and Laboratory Evaluation

Includes thyroid, prolactin, and coagulation tests if hormonal imbalance or systemic causes are suspected.

Treatment Options

The treatment of abnormal uterine bleeding depends on the underlying cause, patient’s age, and fertility plans.
At Saga Clinic, management is tailored to each individual and may include:

1. Medical Treatments

  • Hormonal therapy (combined oral contraceptives, progesterone, or IUDs)
  • Non-hormonal medications to reduce bleeding (tranexamic acid, NSAIDs)
  • Correction of anemia and nutritional deficiencies

2. Minimally Invasive Procedures

  • Endosee Office Hysteroscopy: Visual diagnosis and minor polyp removal
  • Operative Hysteroscopy: Surgical removal of fibroids, adhesions, or polyps under sedation
  • Therapeutic Curettage (D&C): Diagnostic and therapeutic scraping of the uterine lining

3. Surgical Options (If Indicated)

  • Myomectomy: Removal of fibroids while preserving fertility
  • Endometrial ablation: Controlled destruction of the uterine lining for chronic bleeding
  • Hysterectomy: Reserved for severe, treatment-resistant cases or confirmed malignancy

Post-Treatment Follow-up

After treatment, patients are re-evaluated with ultrasound and hormonal monitoring.
In women over 40 or those with risk factors, regular Pap smear, HPV testing, and endometrial surveillance are recommended.

The Saga Clinic Approach

At Saga Clinic in Tirana, Dr. Eser Agar combines clinical expertise with advanced diagnostic tools such as high-resolution ultrasound, office hysteroscopy, and molecular testing to identify the exact cause of bleeding.

The clinic emphasizes:

  • Early detection and prevention
  • Fertility-preserving treatments
  • Minimally invasive and comfortable procedures
  • Individualized patient counseling and long-term management

Advantages for Patients

  • Accurate diagnosis through a step-by-step approach
  • Same-day testing and rapid results
  • Conservative and fertility-preserving treatments
  • Comprehensive evaluation from one medical team
  • Confidential and patient-centered care

Appointments and Contact

To schedule an evaluation for abnormal uterine bleeding, contact Saga Clinic Tirana via online booking or WhatsApp.
Dr. Eser Agar and his team will perform a complete diagnostic workup and develop a personalized treatment plan suited to your reproductive health needs.

For appointment requests or medical inquiries, please contact us using the options below.

📞 Clinic Phone (Office Hours)
+355 69 836 1565
Available Monday–Saturday, 09:00–16:00.

💬 WhatsApp (Outside Office Hours)
+355 69 362 0838
Available outside office hours via WhatsApp Message only.