Toward Optimal Health: The Experts Discuss Abnormal Uterine Bleeding

Jodi R. Godfrey, M.S., R.D.

In This Article


With the vast number of conditions affecting women, gynecological concerns are usually left to the specialists. Every once in a while, however, a topic arises that requires the attention of primary care physicians. Abnormal uterine bleeding is the kind of clinical complaint that touches women across the life span. Irregular bleeding can be indicative of a variety of female ailments from stress and hormonal imbalances to chronic diseases, such as thyroid disease, hepatitis, polycystic ovary syndrome (PCOS), diabetes, or leukemia, in which the most noticeable symptom may be irregular bleeding. Second only to concern about vaginitis, concern about menstrual bleeding can and should be addressed by clinicians.

Abnormal uterine bleeding (AUB) can occur at any age, and the age of onset is highly indicative of the etiology. Against the expected odds, the number one reason for AUB is not cancer but tissue atrophy in older women. It is a common occurrence for the uterus to become fragile and dry, which may eventually produce unexplained bleeding.

Hysterectomy remains an area of concern and contention. Roughly one third to one half of all hysterectomies are performed to address problems related to menstruation, but there are viable alternatives and options that clinicians should be aware of in order to provide counsel and guidance to a woman who must consider having this procedure.

Primary care physicians are well trained to think globally about the medical complications facing women, making the challenge of diagnosing and management of the patient with abnormal vaginal bleeding an important area for consideration and review.

For this issue of the Journal of Women's Health, the author sought the expertise of two specialists, who want to improve the diagnosis and treatment of abnormal uterine bleeding by taking the subject out of the gynecologic specialty and addressing these concerns as part of the whole woman.

Linda Bradley, M.D., is an obstetrician/gynecologist and director of hysteroscopic services at the Cleveland Clinic Foundation, Cleveland, Ohio.

Sarina B. Schrager, M.D., is assistant professor of family medicine at the University of Wisconsin School of Medicine in Madison, Wisconsin.


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