Abnormal Uterine Bleeding

What is abnormal uterine bleeding?

Abnormal uterine bleeding is any heavy or unusual bleeding from the uterus (through your vagina). It can occur at any time during your monthly cycle, including during your normal menstrual period. Bleeding after sex or post-menopause would also be considered abnormal.

Symptoms of abnormal uterine bleeding

Vaginal bleeding between periods is one symptom of abnormal uterine bleeding. Having extremely heavy bleeding during your period can also be considered abnormal uterine bleeding. Very heavy bleeding during a period and/or bleeding that lasts more than 7 days is called menorrhagia. For example, women may bleed enough to soak through 1 or more tampons or sanitary pads every hour.

What causes abnormal uterine bleeding?

A variety of things can cause abnormal uterine bleeding. In most women, abnormal uterine bleeding is caused by a hormonal imbalance. When hormones are the problem, doctors refer to this as dysfunctional uterine bleeding (DUB). Abnormal bleeding caused by hormonal imbalance is more common in teenagers or in women who are approaching menopause.

Other common causes of abnormal uterine bleeding are pregnancy, polycystic ovary syndrome (PCOS), or growths in the uterus. These are called polyps or fibroids and can range from small to large growths. Less common causes include an infection, liver, kidney, or thyroid disease, a bleeding disorder, or cancer of the uterus or cervix.

Abnormal uterine bleeding can occur at any age, but the cause usually depends on your age.

Teens, 20s, and 30s

A common cause of abnormal bleeding in teenagers and young adults is pregnancy. Abnormal bleeding can occur in the first few months of a normal pregnancy. Some birth control pills or intrauterine devices (IUDs) can also cause abnormal bleeding.

Abnormal uterine bleeding during a menstrual cycle can occur when your body does not release an egg from your ovaries (called ovulation) as it should. This is common for teenagers who have just started getting their periods. This creates a hormonal imbalance in which the estrogen in your body makes the lining of your uterus (called the endometrium) grow until it gets too thick. When your body gets rid of this lining during your period, the bleeding will be very heavy. A hormonal imbalance may also cause your body not to know when to shed the lining. This can cause irregular bleeding (“spotting”) between your periods.

40s and early 50s

In the years before menopause and when menopause begins, it is common to have months when you don’t ovulate. This can cause abnormal uterine bleeding, including heavy periods and lighter, irregular bleeding. Thickening of the uterine lining is another cause of bleeding in your 40s and 50s. This thickening can be a warning of uterine cancer. You need to talk to your doctor if you have abnormal uterine bleeding and are in this age group. It may be a normal part of getting older, but it’s important to make sure uterine cancer isn’t the cause.

Post-menopause

Hormone replacement therapy is a common cause of uterine bleeding after menopause. Other causes include endometrial and uterine cancer. These cancers are more common in older people than in younger people. But cancer is not always the cause of abnormal uterine bleeding. Many other problems can cause bleeding after menopause. For this reason, it’s important to talk to your doctor if you have any bleeding after menopause.

How is abnormal uterine bleeding diagnosed?

The tests your doctor orders may depend on your age. If you could be pregnant, your doctor will order a pregnancy test. If your bleeding is heavy, your doctor may want to order a blood test. This will make sure you don’t have a low blood count from the blood loss, which could lead to iron deficiency and anemia.

An ultrasound exam of your pelvic area shows both the uterus and the ovaries. It may also show the cause of your bleeding.

Your doctor may want to do an endometrial biopsy. This is a test of the uterine lining. It’s done by putting a thin plastic tube (called a catheter) into your uterus. Your doctor will use the catheter to remove a tiny piece of the uterine lining. They will send that lining sample to the lab for testing. The test will show if you have cancer or a change in the cells. A biopsy can be done in the doctor’s office and causes only mild pain.

Another test is a hysteroscopy. A thin tube with a tiny camera in it is put into your uterus. The camera lets your doctor see the inside of your uterus. If anything abnormal shows up, your doctor can collect tissue for a biopsy.

Can abnormal uterine bleeding be prevented or avoided?

Most causes of abnormal uterine bleeding are not preventable. However, if a hormonal imbalance is caused by being overweight, losing weight could help. Your weight affects your hormone production. Maintaining a healthy weight can help prevent abnormal uterine bleeding in some cases.

Abnormal uterine bleeding treatment

There are several treatment options for abnormal bleeding. Your treatment will depend on the cause of your bleeding, your age, and whether you want to get pregnant in the future. Your doctor will help you decide which treatment is right for you. If your doctor decides that a hormone imbalance is causing your abnormal bleeding, you and your doctor may decide to wait and see if the bleeding improves on its own.

Some treatment options include the following:

Birth control pills. Birth control pills contain hormones that can stop the lining of your uterus from getting too thick. They also can help keep your menstrual cycle regular and reduce cramping. Some types of birth control pills, especially the progestin-only pill (also called the “mini-pill”), can cause abnormal bleeding. Let your doctor know if the pill you’re taking doesn’t control your abnormal bleeding.

Intrauterine device (IUD). Your doctor may suggest an IUD. An IUD is a small, plastic device that your doctor inserts into your uterus through your vagina to prevent pregnancy. One type of IUD releases hormones. This type can significantly reduce abnormal bleeding. Like birth control pills, sometimes IUDs can be the cause of abnormal bleeding. Tell your doctor if this happens to you.

Dilation and curettage (D&C). A D&C is a procedure in which the opening of your cervix is stretched so that a surgical tool can be put into your uterus. Your doctor uses this tool to scrape away the lining of your uterus. The removed lining is checked in a lab for abnormal tissue. A D&C is done under general anesthesia (while you’re in a sleep-like state).

If you’re having heavy bleeding, your doctor may perform a D&C both to find out the cause and treat the bleeding. The D&C itself often makes heavy bleeding stop. Your doctor will decide if this procedure is necessary.

Hysterectomy. This type of surgery removes the uterus. If you have a hysterectomy, you won’t have any more periods and you won’t be able to get pregnant. A hysterectomy is major surgery that requires general anesthesia and a hospital stay. It may require a long recovery period. Talk to your doctor about the risks and benefits of a hysterectomy.

Endometrial ablation. This is a surgical procedure that destroys the lining of the uterus. Unlike a hysterectomy, it does not remove the uterus. Endometrial ablation may stop all menstrual bleeding. However, some people will have light menstrual bleeding or spotting after endometrial ablation. In rare cases, you may still have regular menstrual periods after the procedure. After endometrial ablation, you should still use some form of birth control even though, in most cases, pregnancy is not likely after the procedure.

Your doctor can do endometrial ablation in several different ways. Newer endometrial ablation techniques do not require general anesthesia or a hospital stay. The recovery time after this procedure is shorter than the recovery time after a hysterectomy.

Living with abnormal uterine bleeding

Abnormal uterine bleeding can impact your life in a negative way. Not being able to predict when bleeding will begin can cause you to be anxious all the time. Also, heavy menstrual bleeding may limit your daily activities during your period. For some people, it even prevents them from leaving the house.

If you have heavy menstrual bleeding, try taking ibuprofen (brand names: Advil, Motrin) during your period (or a few days before you expect your period). Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs can help reduce pain and cramping.

You also should be sure to get enough iron in your diet. Your doctor may prescribe an iron supplement to ensure that you don’t become anemic.

Questions to ask your doctor:

• What is the likely cause of my abnormal uterine bleeding?
• Is my condition serious? Am I at risk for any other health problems?
• Based on the cause, what treatment options do you recommend?
• What are the risks and benefits of this treatment?
• Will the treatment affect my chances of getting pregnant in the future?

Resources

Centers for Disease Control and Prevention: Heavy Menstrual Bleeding

National Institutes of Health, MedlinePlus: Abnormal Uterine Bleeding