What is abnormal uterine bleeding?

Abnormal uterine bleeding is irregular bleeding from the uterus. It may be bleeding that is heavier, lighter, or lasts longer than your usual period. Or it may be bleeding that doesn't occur at your regular time. Sometimes it is caused by changes in hormone levels. It can also be caused by growths in the uterus, such as fibroids or polyps. Sometimes a cause cannot be found.

You may have bleeding when you are not expecting your period. Your doctor may suggest a pregnancy test.

Abnormal uterine bleeding may occur from the teen years until after age 40. In teens, it may improve as menstrual cycles get more regular. Depending on the cause, it may resolve with treatment or on its own.

Symptoms of abnormal uterine bleeding include:

• Getting your period more or less often than normal. A normal adult menstrual cycle is about 21 to 35 days long. A normal teen cycle is about 21 to 45 days.
• Periods that last longer than 7 days.
• Bleeding during your period that is lighter or heavier than usual. With heavy bleeding, you may soak through your pads or tampons often.
• Bleeding when you don't expect to, such as between periods or after sex.

It's important to let your doctor know if you have abnormal uterine bleeding. There are many ways that treatment can help. Medicines, hormone therapy, or both may help reduce bleeding or make your menstrual periods more regular. If these don’t work, surgery may be an option.

Your doctor will ask how often, how long, and how much you have been bleeding. You may also have a pelvic exam, a urine test, blood tests, and possibly an ultrasound. Your doctor may also take a tiny sample (biopsy) of tissue from your uterus for testing.

Medicines can help stop or reduce bleeding. They can also help make your bleeding more regular.

Medicine choices

Several hormone treatments can manage bleeding.

Birth control pills, patch, or ring.

These can help control your cycle and reduce bleeding and cramping.

The levonorgestrel intrauterine device (IUD).

This is a birth control device that your doctor places inside your uterus. It releases progestin and can reduce bleeding and cramping.

Progestin-only birth control.

This can include mini-pills, implants, or shots. These types of birth control can reduce bleeding and cramping.

Progestin pills (synthetic progesterone.).

These are progestin-only pills that can help reduce bleeding but don't prevent pregnancy.

Estrogen.

In some severe or urgent cases, estrogen may be used to reduce bleeding.

Other non-hormonal medicines can also be used for treatment.

Nonsteroidal anti-inflammatory drugs (NSAIDs).

Taking an NSAID can reduce bleeding and pain during your period.

Tranexamic acid.

This is medicine reduces bleeding by helping your blood to clot.

Any of the following health professionals can do an initial evaluation of a vaginal bleeding problem:

• Nurse practitioner
• Physician assistant
• Family medicine physician
• Internist
• Gynecologist

If you need more evaluation or surgery, your doctor may refer you to a gynecologist.

Medicine can help with menstrual pain and reduce bleeding. Ask your doctor if you can use an over-the-counter nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin). Heavy bleeding can cause low levels of iron in your blood (anemia). You can help prevent anemia by eating more foods that have iron, such as red meat or eggs.

Surgery may be done to treat bleeding that isn't controlled with medicine.

Surgery choices

Several procedures are used to treat bleeding.

• Hysteroscopy can be used to diagnose and treat bleeding at the same time. A lighted viewing scope is placed through the vagina and cervix and into the uterus. Biopsies can be taken where there is bleeding. The bleeding can be treated with either a laser beam or electric current.
• Hysterectomy is the removal of the uterus. It may be done when a biopsy shows abnormal cell changes or cancer. It also can be done when bleeding can't be controlled or when the cause of long-term bleeding can't be found and treated.
• Endometrial ablation is another choice when other medical treatments don't work or when you or your doctor have reasons for not using other treatments. It scars the uterine lining, so it is not an option if you are planning to become pregnant.

Abnormal uterine bleeding has many causes. It's sometimes caused by changes in hormone levels. It can also be caused by problems such as growths in the uterus or clotting problems. In rare cases, it may be caused by a more serious problem, such as cancer. Sometimes the cause of the bleeding isn't known.

Abnormal uterine bleeding is irregular bleeding from the uterus. It may be bleeding that is heavier, lighter, or lasts longer than your usual period. Or it may be bleeding that doesn't occur at your regular time. For example, you may have heavy bleeding during your period or in between periods. Let your doctor know if your bleeding is different than usual. They can check for problems.

Bleeding during pregnancy is a different problem. If you are pregnant and have any amount of bleeding from the vagina, be sure to tell your doctor.