The normal female reproductive system has two ovaries, two fallopian tubes and a uterus (womb).

• The ovaries are where human eggs are made.
• The fallopian tubes provide a pathway for the eggs to travel from the ovaries to the uterus.
• The uterus is the organ that nourishes and protects a growing baby during pregnancy.
• The cervix is the opening of the uterus into the vagina.

The endometrium is the tissue that lines the uterus. It is shed from the female body every month during menstruation.

• Abnormal uterine bleeding (AUB) is any vaginal bleeding that is different from a normal menstrual pattern. This includes bleeding or spotting after menopause.
• The most common type of AUB is menorrhagia. Menorrhagia is heavy or prolonged bleeding at normal monthly intervals.
• AUB can occur at any age. However, it is most common when menses starts or when a woman is approaching menopause.

There are multiple causes of abnormal uterine bleeding. These causes include:

• Pregnancy and pregnancy-related complications
• Use of oral contraceptives or other birth control methods
• Infection, cancer, injury or other disorders of the uterus or cervix
• Blood-clotting disorders and chronic diseases, such as diabetes or thyroid disorders
• Recent injury or trauma to the cervix or uterus
• Certain medications or herbal supplements
• Hormonal factors

Some causes of abnormal uterine bleeding can be serious. If a specific cause is not found, abnormal uterine bleeding is generally thought to be due to hormonal factors. Contact your healthcare provider if you have vaginal bleeding that is different from your normal menstrual flow or occurs after menopause. Your provider will ask about your symptoms and do a physical exam, which will include an examination of your pelvic area (internal exam). They may also order:

• Lab work
• A pap smear
• An abdominal or vaginal ultrasound

Your healthcare provider may recommend a uterine biopsy to help determine the cause of your abnormal uterine bleeding. During this procedure, a sample of the endometrium is removed to check for abnormal, or cancerous, cells. If a uterine biopsy is recommended, prior to the procedure tell your healthcare provider about any medications you are taking (including over-the-counter medications and supplements). You should also ask about specific instructions to follow before and after the procedure. These include:

• Medications you should not take before the procedure, such as blood thinners or aspirin
• Regular medications you should continue to take on the day of your procedure
• How many hours you should stop eating and drinking before the procedure
• Any activities you should not do just before or after the procedure (such as sexual activity and douching)

To make the procedure more comfortable:

• Empty your bladder and bowels before the procedure
• Take slow deeps breaths during the procedure to help you relax

This care path includes the cost of 2 office visits, an ultrasound, and a uterine biopsy performed in the healthcare provider's office.

Make an appointment with your healthcare provider if you have abnormal uterine bleeding.Be prepared to discuss your symptoms and how long you have had them.

• Bring a copy of your medical history (past illnesses, surgeries, and hospitalizations).
• Make a list of your medications (including over-the-counter).
• Write down any questions, symptoms or concerns you want to talk about.
• If your healthcare provider prescribes a medication for you, ask for a generic version.
• If your healthcare provider thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).

What should I ask my healthcare provider before having a uterine biopsy?

• What is the reason for the procedure? Are there any alternatives?
• What happens if I don't go through with the procedure or perform any other treatment?
• Is there any other special preparation for the procedure? (If so, get clear instructions on what you need to do.)
• Will I need sedation? What are the possible side effects?
• What are the possible complications?
• How will I feel after the procedure, and how will I have to modify my activity?
• Will I need someone to drive me home?

Source UHC.com

Also known as:

Vaginal Bleeding

Hysterectomy

AUB

Abnormal Uterine Bleeding - Office Visit