This article is written by medical professional Dr. Alice Byram, whom you can read more about at the end of the article.

What is Abnormal Uterine Bleeding (AUB) and Breakthrough Bleeding?

If you have been tracking your period you may notice some unexpected bleeding whether it be bleeding when you don’t expect it or a change in the quantity and quality of the bleeding. You might notice that your flow has become heavier than usual or that it has changed in colour. This is abnormal uterine bleeding. You may have heard the term breakthrough bleeding, this is now usually used to mean bleeding in between periods for oral hormonal contraception users (the pill).

How Do I Know If I Have Breakthrough or Abnormal Uterine Bleeding?

The clue is in the name, abnormal! The key is knowing what is “normal” for you. Every person with a period is different. Keeping track of not only the days you are bleeding, but how much and what type of bleeding you have will mean that you will be able to identify what is abnormal bleeding. The easiest way to do this is by using an app. A few taps and you will be able to record what is going on with your menstrual cycle. Any changes in what is normal for you or any of the symptoms listed below are reason enough for you to consult your doctor. 

• Bleeding for more than 8 days, needing to change pads or tampons during the night, or any other signs of heavy bleeding. 
• Bleeding after the menopause.
• Bleeding between your periods.
• Bleeding when pregnant or if you think you may be pregnant. 
• Unexpected bleeding with cramps.
• Bleeding after a recent abortion.

What Causes Abnormal Uterine Bleeding?

Abnormal uterine bleeding can be caused by a number of different events, not all of them mean that you have to see a doctor. 

• Starting hormonal contraceptives: during the first few months on the pill you can have irregular bleeding. Missing pill doses can also lead to breakthrough bleeding. Remember to use additional contraception, not just for the days you didn’t take the pill, but also the rest of your cycle until your next period. 
• IUD (Intra uterine device) insertion: you can expect some spotting but any prolonged or painful bleeding and you should speak to the health care professional who inserted it.
• Ectopic pregnancy: when the fertilised egg implants outside of the uterus, unexplained bleeding with pain (including back pain) may be all that you notice. 
• Spontaneous miscarriage
• Pregnancy implantation bleeding: sometime you may notice spotting when your period is due which is the embryo implanting itself into the uterine wall. 
• STIs (Sexually transmitted infections): If you have a new partner or your current partner and yourself have never had a sexual health check-up, find a confidential clinic or speak to your doctor. 
• Fibroids
• Polyps
• Endometriosis
• PCOS
• Uterus or womb cancer
• Menopause: The perimenopause or the years leading up to your last period can lead to irregular periods but anything unexpected must be checked out by your doctor. 

There are many places you can bleed from, not just from the uterus. Sometimes it is hard to know where you are bleeding from as it just presents as spotting or bleeding coming out of your vagina.  Some of the causes of bleeding from your vagina can be: 

• Vaginal or vulval cancer
• Vaginal dryness
• Vaginal injury through penetrative sex

What Can I Do About AUB or Breakthrough Bleeding?

The first step is to track your menstrual cycle and make a note of how and when you are bleeding. Tracking apps such as Clue can make it easier and are also available to create a report with variations in your cycle which you may not have realised. Taking this to your doctor will be very helpful.

If you do identify any irregularities, it is important that you speak to your doctor instead of trying self-diagnosis. Google may give you some ideas as to what is going on but you will be quickly reassured or receive the treatment you need as soon as you go to see your doctor.

Practising safe sex means that you will avoid unwanted pregnancies but also sexually transmitted diseases. Remember even if you have been having sex with the same person for a year, unless you have both been tested for sexually transmitted infections, your risk of infection is the same as the first time. Treatments exist for STIs (sexually transmitted infections) which mean you can live a normal life. HIV, for example, correctly treated can lead to an undetectable viral load which means it is almost impossible to transmit it to someone else and you don’t progress to AIDs. 

Traditionally, women who were pregnant and started bleeding were prescribed full bed rest. This is no longer the case. Reducing strenuous activity is probably sensible but you can continue to live a normal life depending on what your own personal situation is. Certain complications such as placenta previa might require you to rest more so always follow the indications of your obstetrician. 

Breakthrough bleeding can occur due to missed or late contraceptive pills, and is something to try to avoid. Putting an alert (or two) on your phone is a good way of making sure that you take your contraceptive pills on time every day. As is linking them to another habit that you will do every day, such as brushing your teeth or having coffee. If you do forget, add a pack of condoms to your shopping list as you won’t be covered for the rest of your cycle. You can get pregnant even if  you remember to take the rest of your contraceptive pills the following days.  

Using a menstrual cup means that you will be able to see just how much you are bleeding unexpectedly.

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 Written by Dr Alice Byram Bsc Med & Surg UMA MA Hons MML Cantab

Dr Alice Byram was born in England to a French-British family. Following on from a degree in Spanish from the University of Cambridge, she went to Spain to study medicine. On her return to the UK, she worked in Emergency Medicine for several years before recently returning to Barcelona.