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Chapter 3: Common Causes of Abnormal Uterine Bleeding


(calming music) – If you’re in any kind of pain like that or you’re constantly bleeding, which means you’re constantly worn out, it definitely doesn’t
hurt to ask about it. – Now let’s talk about some of the causes of abnormal bleeding. The first thing that I’d like to emphasize is that when you’re
speaking to your provider about abnormal uterine bleeding, it’s very important that you get a chance to explain exactly what’s going on. And that your provider
takes a complete history and does a good physical examination. Even with all the sophisticated
tests we have today, the most important things that we do still involve listening to
patients and doing a good exam. – So whenever a patient comes
to me with abnormal bleeding, and I start to do an evaluation, I’m pretty much thinking about
one of two possibilities. Either a structural problem, some sort of the growth within the uterus, such as fibroids or polyps,
which are very common. Or some sort of hormonal imbalance which is making the lining
of the uterus disordered and making the bleeding unpredictable. With regards to the structural problems, fibroids are an extremely common source of abnormal bleeding. As many as 30-70% of women have fibroids, but not all fibroids
cause abnormal bleeding. If they’re just big enough or
located just in the right spot to interrupt the lining of the uterus, they’re notorious for
causing abnormal bleeding. And aside from cancers, the most common reason
for abnormal bleeding amongst most women. – Polyps are small glandular growths that occur in the inside of the uterus. They’re generally benign
and not cancerous, but they are often associated
with abnormal bleeding. Any woman who has post-menopausal bleeding of an unexplained source, needs to bring it to the
attention of her provider, no matter how minimal or
infrequent that bleeding occurs. Because endometrial cancer
is a fairly common cancer in post-menopausal
women and can be treated and cured in most cases. So it’s very important to
bring post-menopausal bleeding to your providers attention. Now let’s talk about
causes of abnormal bleeding that are not related to abnormal growths. The most common are related
to hormonal imbalances. We see these often in patients who are on a birth control pill, or who have ovulatory issues
and don’t ovulate every month. Other common causes include infections and bleeding disorders. Among the most common causes
that we see is adenomyosis. Adenomyosis of the uterus
is similar to endometriosis, where there is an abnormal growth of endometrial lining cells. Endometriosis is when the
endometrial lining cells populate the pelvis. And adenomyosis is when these
cells grow into the muscle layer of the uterus. This is most commonly
seen for women who have abnormal bleeding after childbirth and it is often not
responsive to being treated with birth control pills. Endometrial hyperplasia
is another condition that’s commonly associated
with hormonal imbalances. Endometrial hyperplasia
is an abnormal thickening of the uterine lining, and it may be a pre-cancerous condition and so it should always be thoroughly assessed and diagnosed. (calming music)

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