Dealing with Abnormal Uterine Bleeding

For many women, menstrual periods last anywhere from three to five days. However, some women experience bleeding in between periods and at varying points during their menstrual cycle.

This is called abnormal uterine bleeding (AUB), a condition characterized by menstrual bleeding of abnormal quantity or duration. Abnormal uterine bleeding is responsible for nearly one-third of outpatient visits to a gynecologist.

With AUB, bleeding episodes usually take place less than 21 days apart. If you have AUB, you may have heavier or longer periods than usual, with bleeding that lasts more than seven to 10 days. However, some women may not have any bleeding at all, which is also abnormal.

AUB has several underlying causes, including a uterine or cervical infection, birth control methods such an intrauterine device, fibroids or pregnancy. If you have abnormal bleeding at any point during your menstrual cycle, it may be time to see a doctor.

Causes of Abnormal Uterine Bleeding

Abnormal uterine bleeding happens to women of all ages. Some women experience irregular periods at some point during their menstrual history, including during perimenopause and when they first begin their period. Though this is normal in certain cases, other factors can cause prolonged bleeding that may require medical attention.

These causes include endometrial polyps, a growth that attaches to the inner lining of the uterus; adenomyosis, a condition in which tissue grows on the muscle wall of the uterus; or neoplasia, which is abnormal tissue growth. Fibroids and blood clotting disorders also can cause abnormal uterine bleeding. Abnormal uterine bleeding is most commonly associated with ovulatory dysfunction, which occurs when a woman has menstrual cycles when she does not ovulate.

In more serious cases, miscarriage, an ectopic pregnancy (when an embryo grows outside the uterus), or uterine, cervical or vaginal cancer may be the root cause of the bleeding. Because many factors can cause AUB, it’s difficult to determine a proper diagnosis without a thorough medical evaluation.

Diagnosis and Treatment Options

Before you visit a doctor, begin to track your menstrual periods and when you experience abnormal bleeding during your cycle. We will review these notes and ask you about your personal medical history and family health history. We’ll also perform an evaluation to rule out pregnancy, another common cause of AUB. We also might order blood tests to check your hormone levels and to exclude certain blood disorders.

All women with AUB should be appropriately screened for cervical cancer via a pap smear, so we will perform a physical exam to determine whether the bleeding is coming from the uterus, cervix or vagina. If you have an increased risk of cancer or endometrial hyperplasia (thickening of the uterine lining) or are over age 45, we will take a sample of the uterine lining to determine if either of these two conditions could be the cause of the bleeding. If you are younger than 45 and have persistent AUB, are overweight and do not ovulate, a medical evaluation is also necessary to rule out more serious conditions.

If you have UAB, the treatment approach will depend on the cause of the bleeding, your age and whether you want to have children. Hormone medicines and birth control pills can help to control abnormal bleeding and make your periods more regular. Antibiotics and anti-inflammatory drugs such as ibuprofen also are effective treatment options.

If you have polyps or fibroids, you may need surgery to remove these growths and to address abnormal uterine bleeding. In more severe cases, we may use endometrial ablation to treat AUB. This procedure involves using a laser or heat to destroy the uterine lining. The uterine lining then scars and heals, which reduces or prevents abnormal bleeding. If all other treatment options haven’t worked, we may consider a hysterectomy to remove the uterus. However, since the option stops a woman’s periods and prevents pregnancy, it only may be suitable for women who are nearing menopause or don’t intend to have children or expand their families.

Abnormal uterine bleeding can be a very challenging condition to deal with. However, there are several treatment options that can help. Most women experience their period for no more than a week, so if you have prolonged or sporadic bleeding outside this time frame, see your doctor as soon as possible.