Abnormal uterine bleeding is one of the most common reasons women see their doctors. It can occur at any age and has many causes. Some are easily treated, while others are more serious. Finding the cause is the first step in treatment. 

This page will explain:

If your cycles are irregular, see your doctor. Abnormal bleeding can have a number of causes. 

If you are experiencing signs or symptoms of this issue, or have questions, you can schedule an appointment with us at our Baldwin Park office in Orlando, FL.

The Normal Menstrual Cycle 

During the menstrual cycle, two hormones, called estrogen and progesterone, are made by the ovaries. Each month, these hormones cause the endometrium to grow in preparation for a possible pregnancy. About 12–14 days before the start of the period, an egg is released from one of the ovaries. This is called ovulation. The egg then moves into one of the fallopian tubes. There it can be fertilized by a sperm. If it is not, pregnancy does not occur. The levels of hormones decrease. This decrease is a signal for the uterus to shed its lining. This shedding is the menstrual period. 

The cycle begins with the first day of bleeding of one period and ends with the first day of the next. In most women, this cycle lasts about 28 days. Cycles that are shorter or longer by up to 7 days are normal. 

Abnormal Bleeding 

Bleeding in any of the following situations is abnormal:

Menstrual cycles that are longer than 35 days or shorter than 21 days are abnormal. The lack of periods for 3–6 months (amenorrhea) also is abnormal. 

Abnormal bleeding can occur at any age. At certain times in a woman’s life it is common for periods to be somewhat irregular. They may not occur on schedule in the first few years after a girl starts to have them (around age 9–16 years). The cycle may get shorter near age 35 years. It often gets shorter as a woman nears menopause (around age 50 years). It also is normal then to skip periods or for bleeding to get lighter or heavier. 

Causes 

Abnormal bleeding can have many causes. Your doctor may start by checking for problems most common in your age group. Some of them are not serious and are easy to treat. Others can be more serious. All should be checked. 

In some women, too much or not enough of a certain hormone can cause abnormal or heavy bleeding. This imbalance can be caused by many things, such as thyroid problems or some medications.

Other Causes of Abnormal Bleeding 

Other causes of abnormal uterine bleeding include:

Diagnosis 

To find the cause, your doctor will ask about your personal and family health history. You may be asked about these issues:

Your doctor also will ask about your menstrual cycle. You can help by keeping track of it before your visit. Note the dates, length, and type (light, medium, heavy, or spotting) of your bleeding on a calendar (see “Menstrual Flow Diary”). Your doctor can use your notes to help pinpoint the problem. 

You will have a physical exam. You also may have blood tests. These tests check your blood count and hormone levels and rule out some diseases of the blood. You also may have a test to see if you are pregnant. Based on your symptoms, other tests may be needed:

Some of these tests can be done in your doctor’s office. Others may be done at a hospital or surgical center. 

Treatment 

Treatment will depend on many factors, including the cause of the bleeding. Your age and whether you want to have children also play a role. Treatment falls into three types. You may be given medications, such as hormones. You may need to have surgery. You may decide with your doctor to “watch and wait” before trying the other two treatments. Most women can be treated with medications. 

To judge how well treatment is working, you may need to be tested again. If you think you might be pregnant, let your doctor know before you start any treatment. 

Hormones 

Hormones can control some abnormal bleeding. It may take a few months. Your periods may be heavier at first. However, they usually will lighten over time. If they do not, let your doctor know. The type of hormone you take will depend on whether you want to get pregnant as well as your age. 

Hormones can be given in different ways. Your doctor may prescribe birth control pills to help make your periods more regular. Hormones also can be given as an injection, as a vaginal cream, or through an IUD that releases hormones. An IUD is a birth control device that is inserted in the uterus. The hormones in the IUD are released slowly and may control abnormal bleeding.

Bleeding may be caused by endometrial hyperplasia. This condition occurs when the lining of the uterus grows too thick. Progesterone can help treat and prevent it. 

Other Medications 

Nonsteroidal antiinflammatory drugs, like ibuprofen, may help control heavy bleeding. They also may be used to relieve menstrual cramps. If you have an infection, you will be given antibiotics. 

Surgery 

Some women may need to have surgery to remove growths (such as polyps or fibroids) that cause bleeding. This often can be done with hysteroscopy. Sometimes other techniques are used. 

Endometrial ablation may be used to control bleeding. This treatment uses electricity, laser, heat, or freezing to destroy the lining of the uterus. It is intended to stop or reduce bleeding permanently. A woman may not be able to get pregnant after ablation. An endometrial biopsy is needed before ablation is considered. 

Hysterectomy may be done when other forms of treatment have failed or they are not an option. This is major surgery. Afterward, a woman no longer has periods. She also cannot get pregnant. Discuss all of your options with your doctor before choosing a treatment. 

Finally 

If you are having abnormal bleeding, see your doctor. Abnormal bleeding can have a number of causes. There is no way to tell why your bleeding is abnormal until your doctor examines you. Once the cause is found, it often can be treated with success. If it persists or returns, you should see your doctor again. 

If you are experiencing signs or symptoms of this issue, or have questions, you can schedule an appointment with us at our Baldwin Park office in Orlando, FL.

Glossary 

Source: acog.org