Abnormal uterine bleeding is one of the most common reasons women see their health care providers. It can occur at any age and has many causes. Finding the cause is the first step in treatment.

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 to 14 days before the start of the menstrual 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 menstrual 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 seven days are normal.

Definition of Abnormal Uterine Bleeding

• Bleeding in any of the following situations is abnormal:
• Bleeding between periods
• Bleeding after sex
• Spotting anytime in the menstrual cycle
• Bleeding heavier or for more days than normal
• Bleeding after menopause

Menstrual cycles that are longer than 35 days for shorter than 21 days are abnormal. The lack of a period for three to six months (amenorrhea) is also abnormal.

Abnormal uterine 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 to 16 years). The length of the menstrual cycle may change as a woman nears menopause around age 50 years. It also is normal to skip periods or for bleeding to get lighter or heavier at this time.

Causes

Abnormal uterine bleeding can have many causes. They include:  pregnancy, miscarriage, ectopic pregnancy, adenomyosis, use of some birth control methods such an intrauterine device (IUD) or birth control pills, infection of the uterus or cervix, fibroids, polyps, problems with blood clotting, endometrial hyperplasia, certain types of cancer, and polycystic ovary syndrome. Sometimes, abnormal uterine bleeding is caused by too much or not enough of certain hormones. If can be caused by growths such as polyps or fibroids. Medications such as birth control pills can cause abnormal uterine bleeding.

Diagnosis

Your health care provider will ask about your personal and family healthy history. You may be asked about these issues:

• Past or present illnesses
• Use of medications
• Use of birth control
• Weight, eating and exercise habits and level of stress

You will be asked 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. This record may be useful in finding the cause of your bleeding.

Your health care provider may start by checking for problems that are most common in your age group. You will have a physical exam and you 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:

• Sonohysterography—Fluid is placed in the uterus through a thin tube while ultrasound images are made of the uterus.
• Ultrasound—Sound waves are used to make a picture of the pelvic organs.
• Magnetic resonance imaging—In this imaging test, powerful magnets are used to create images of the internal organs.
• Hysteroscopy—A thin device is inserted through the vagina and the opening of the cervix. It lets your health care provider view the inside of uterus.
• Endometrial biopsy—Using a narrow tube called a catheter, tissue is taken from the lining of the uterus. It is looked at under a microscope.

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

Treatment

Treatment depends on many factors including the cause of the bleeding, your age, and whether you want to have children. Many women with abnormal uterine bleeding can be treated with medication. Others may need surgery.

Hormonal Medications

Hormones can control abnormal uterine bleeding in some cases. Hormones can be given in different ways. Your health care provider may prescribe birth control pills to help make your periods more regular. Hormones also can be given as an injection, vaginal cream via an IUD.

Other Medications

Nonsteroidal anti-inflammatory drugs may help control heavy bleeding. One type is ibuprofen. These drugs also may be used to relieve menstrual cramps. Tranexamic acid is a drug that is used to treat heavy menstrual bleeding. If you have an infection, you may be given an antibiotic.

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 become pregnant after an ablation. An endometrial biopsy is needed before an 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 your options with your health care provider before choosing a treatment.

Finally . . .

If you are having abnormal bleeding, see your health care provider. Abnormal bleeding can have many causes. Once the cause if found, it often can be treated with success.