Abnormal Bleeding

Abnormal uterine bleeding is irregular bleeding from the uterus. It may be bleeding that is heavier, lighter, lasts longer than your usual period, or 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.

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