Also called as menorrhagia, heavy menstrual bleeding, dysfunctional uterine bleeding – abnormal uterine bleeding (AUB) is simply defined as “excessive menstrual blood loss which interferes with a woman’s physical, social, emotional and/or material quality of life”.

The excessive loss can be due to timing, volume and/or regularity. So what is important is the perceived effect on someone’s well being.

Abnormal uterine bleeding can be caused by different pathologies, broadly divided into anatomical/ structural of genital tract and non-structural.

Potential structural causes are:

• Polyp – either cervical or endometrial
• Adenomyosis – abnormal endometrial tissue infiltrating into myometrium (muscle layer of the womb).
• Fibroid – benign tumour of uterus (womb)
• Malignancy or hyperplasia – cancer or overgrowth of the uterine lining

Non structural causes such as:

• Bleeding disorder – more common in younger women/ teens
• Ovulation disorder – for example Polycystic Ovarian Syndrome
• Hormonal instability affecting endometrial lining
• Use of blood thinners – warfarin, heparin, new anti coagulants

Dr Sem will carefully take your history and perform a clinical examination to ascertain the cause of your problem.

To determine the most likely cause of abnormal uterine bleeding, further investigations may be required.

Some investigations or tests can be performed by Dr Sem in his rooms, for example:

• High Definition and 3D Ultrasound
• Pap Smear
• Endometrial Biopsy
• Vaginal Swabs
• Colposcopy

Dr Sem may refer you for additional testing, which may include:

• Blood tests
• Detailed Ultrasound Scan
• Computed Tomography (CT) Scan
• Magnetic Resonance Imaging

In some cases, to rule out benign tumour, malignancy or cancer, a diagnostic procedure may be required.

This procedure is called hysteroscopy, where a 4 mm camera is inserted into the womb to completely visualise uterine cavity. A sampling biopsy is always performed at the same time.

Dr Sem offers personalised treatment plan for his patients. Every woman is unique, with different clinical condition, stage of life and fertility requirements. There is not one solution that will fit all. With his expertise, Dr Sem will assist his patients in making the best treatment decision.

The treatment can be divided broadly into :

• Medical Non-Hormonal, e.g. Tranexamic acid
• Hormonal, e.g. GnRH agonist/ antagonist, Mirena Intrauterine System
• Surgical, e.g. myomectomy, hysterectomy

Dr Sem is an expert laparoscopic gynaecological surgeon, and can offer his patients the minimally invasive route to treat abnormal uterine bleeding.

This will allow a quicker recovery, less pain and earlier return to daily activities.