Abnormal Uterine Bleeding

What Is Abnormal Uterine Bleeding?

Abnormal uterine bleeding is when you bleed outside of your normal monthly period. You might hear it called anovulatory bleeding. Your flow could also be heavier or last longer than what’s typical.

When it comes to menstrual cycles, there’s a wide range of “normal.” But your period shouldn’t be a problem for you month after month. If it’s so heavy or unpredictable that it keeps you from doing some activities or makes you miss work or school, you may have a medical condition that should be treated.

Abnormal Uterine Bleeding Symptoms

The signs of abnormal uterine bleeding include:

• Heavy period (menorrhagia)
• Bleeding between your periods, after sex, or during menopause
• Long periods (more than 7 days)
• Irregular periods

Doctors check these things when diagnosing abnormal uterine bleeding:

• How often you get your period. It should be fairly regular. The length of each cycle shouldn’t change by more than a week. If it’s shorter than 3 weeks or longer than 5, that could be a sign of a problem.
• How long it lasts. A typical period lasts 4 or 5 days. If yours is often less than 2 days or longer than a week, that could mean something’s wrong.
• How heavy it is. Most women only lose about 2 tablespoons of blood each period. More than 5 tablespoons is thought to be unusually heavy, but that’s hard to judge. Let your doctor know if you need more than one tampon or pad in an hour. Abnormally heavy menstrual bleeding is called menorrhagia.
• Whether you have spotting between periods.
• Whether you have bleeding after sex.

If you could be pregnant or you’re past menopause and have any kind of bleeding, call your doctor.

Some spotting is common early in pregnancy, but bleeding can be a sign of a serious condition called an ectopic pregnancy. That’s when a fertilized egg implants somewhere outside your uterus, most commonly in a fallopian tube. It could also mean you’re having a miscarriage.

After menopause, women who take hormone replacement therapy may still have periods. But any bleeding should be checked out.

Abnormal Uterine Bleeding Causes

There are a few possible causes behind abnormal uterine bleeding:

Hormone changes. Problems with your hormones are the most common reason for abnormal uterine bleeding. When one of your ovaries releases an egg (called ovulation), certain hormones tell your body to build up and then shed the lining of your uterus (called the endometrium). With teenagers and women getting close to menopause, the endometrium can build up too much. That can lead to an irregular or heavy period or spotting between periods.

These things can throw off your hormones, too:

• Birth control pills and other medicines like warfarin and hormone therapy
• Fast weight loss or gain
• Emotional or physical stress
• An intrauterine device (IUD)
• Polycystic ovary syndrome (PCOS)

Problems with your uterus. Another possible reason for abnormal bleeding is a physical problem with your uterus. Millions of women have fibroids -- noncancerous tumors that grow in the muscles of the wall of the uterus. A polyp is another kind of growth that can form in the lining of your uterus. A condition called adenomyosis is where the cells similar to the ones that grow in the lining of the uterus start to grow in the muscle part of the uterus. Endometriosis can also cause abnormal bleeding. This is when tissue like the kind that lines the inside of your uterus grows outside of your uterus.

Other health conditions. These are much less common, but abnormal uterine bleeding also can result from:

• Bleeding or clotting disorders or blood-thinning medicines
• Cancer of the cervix, endometrium, or uterus
• Illnesses that affect your kidneys, liver, thyroid, or adrenal glands
• Infection of your cervix or endometrium
• Sexually transmitted diseases

Abnormal Uterine Bleeding Diagnosis

It can help to take detailed notes over a few cycles so you can give the doctor specific information about your symptoms. They’ll also ask about your overall health and give you a physical exam. You’ll probably get a pregnancy test, and you may also have:

• Blood work. Heavy bleeding can leave your body short of iron. A blood test can see if that’s a problem for you. It can also show if your hormones are out of balance or if you have a blood disorder or chronic disease.
• Ultrasound. This uses sound waves to make images of the inside of your uterus so your doctor can look for fibroids or polyps.
• Hysteroscopy. The doctor will look inside your uterus with a tiny lighted scope that they put in through your cervix.
• Biopsy. The doctor may take out a small piece of tissue and check it under a microscope for abnormal cells.
• Magnetic resonance imaging. This test uses radio waves and powerful magnets to make detailed pictures of your uterus. It isn’t used that often, but it can help spot adenomyosis.

Abnormal Uterine Bleeding Treatment

Your treatment will depend on the cause of the abnormal uterine bleeding -- if a chronic illness or a blood disorder is at the root of your symptoms, treating that can help.

Treatment also can depend on whether you plan to have children. It might not be safe to get pregnant after some treatments, while others can make it impossible. If you’re close to menopause, the doctor may want to take a wait-and-see approach because your symptoms may get better on their own.

Drugs are usually the first thing your doctor will try. They include:

• Hormones.Birth control pills and other hormone treatments may be able to give you regular menstrual cycles and lighter periods.
• Gonadotropin-releasing hormone agonists (GnRHa). These stop your body from making certain hormones. They can shrink fibroids for a while, but they’re usually used along with other treatments.
• NSAIDS. If you take anti-inflammatories like ibuprofen or naproxen a few days before your period starts, they may help lighten the bleeding.
• Tranexamic acid. This is a pill that helps your blood clot and can control heavy uterine bleeding.
• IUD. For some women, an IUD that releases a hormone called progestin can stop heavy bleeding. Many women who use one don’t get a period at all.

Sometimes surgery can be needed to stop the bleeding:

• Endometrial ablation. This uses heat, cold, electricity, or a laser to destroy the lining of your uterus. It may end your periods entirely. You probably won’t be able to get pregnant after having it done, but it can be dangerous if you do. You’ll need to use birth control until menopause.
• Myomectomy or uterine artery embolization. If you have fibroids, the doctor may take them out or cut off the vessels that supply them with blood.
• Hysterectomy. This is when the doctor removes your uterus. You may need a hysterectomy if your fibroids are very large or you have endometrial or uterine cance r. Otherwise, it’s a last resort when other treatments haven’t worked.

Abnormal Uterine Bleeding Complications

Complications that may happen with abnormal uterine bleeding include:

• Trouble getting pregnant
• Anemia or blood loss
• Higher risk of endometrial cancer

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