Symptoms

Abnormal uterine bleeding is unpredictable. The bleeding may be very heavy or light, and can occur often or randomly.

Symptoms include:

• Bleeding or spotting between periods

• Bleeding or spotting after sex

• Heavy bleeding during your period

• Bleeding that soaks through one or more tampons or pads every hour

• Bleeding that lasts more than 7 days

• Menstrual cycles that are shorter than 21 days or are longer than 35 days

• Not having a period for 3 to 6 months

• Bleeding after menopause

Other symptoms caused by changes in hormone levels may include:

• Excessive growth of body hair in a male pattern (hirsutism)

• Hot flashes

• Mood swings

• Tenderness and dryness of the vagina

A woman may feel tired or fatigued if she loses too much blood over time. This is a symptom of anemia.

Causes

In many women, abnormal uterine bleeding is caused by hormone imbalance. It can also occur due to following causes:

• Hormonal birth control, such as birth control pills or intrauterine devices (IUD)

• Lack of ovulation

• Uterine fibroids or polyps

• Polycystic ovary syndrome

• Bleeding disorders or problems with blood clotting

• Severe weight loss

• Excessive weight gain or loss (more than 10 pounds or 4.5 kilograms)

• Infection of the uterus or cervix

• Cancers of ovaries, uterus, cervix, or vagina

Diagnosis

Your provider will rule out other possible causes of irregular bleeding. You will likely have a pelvic exam and Pap/HPV test. Other tests that may be done include:

• Complete blood count (CBC)

• Fasting blood glucose

• Hormone tests

• Pregnancy test

• Thyroid function tests

The following may also be recommended:

• Culture to look for infection

• Biopsy to check for precancer, cancer, or to help decide on hormone treatment

• Hysteroscopy, performed in your provider's office to look into the uterus through the vagina

• Ultrasound to look for problems in the uterus or pelvis

Treatment

Treatment may include one or more of the following:

• Low-dose birth control pills

• Hormone therapy

• High-dose estrogen therapy for women with very heavy bleeding

• Intrauterine device (IUD) that releases the hormone progestin

• Nonsteroidal anti-inflammatory drugs (NSAIDs) taken just before the period starts

• Surgery, if the cause of the bleeding is a polyp or fibroid