Condition Basics

What is abnormal uterine bleeding?

Abnormal uterine bleeding is irregular bleeding from the uterus that is longer or heavier than usual or that doesn't occur at your regular time. For example, you may have heavy bleeding during your period or in between periods.

What causes it?

Abnormal uterine bleeding has many causes. It's sometimes caused by changes in hormone levels. It can also be caused by problems such as growths in the uterus or clotting problems. In some cases the cause of the bleeding isn't known.

What are the symptoms?

Symptoms of abnormal uterine bleeding include periods that happen more often, seem heavier than normal, or last longer. For example, you may have abnormal uterine bleeding if your period lasts longer than 7 days (normally 4 to 6 days).

How is it diagnosed?

Your doctor will ask how often, how long, and how much you have been bleeding. You may also have a pelvic examination, a urine test, blood tests, and possibly an ultrasound. Your doctor may also take a tiny sample (biopsy) of tissue from your uterus for testing.

How is abnormal uterine bleeding
treated?

It's important to let your doctor know if you have abnormal uterine bleeding. There are many ways to help treat it. Some are meant to return the menstrual cycle to normal. Others are used to reduce bleeding or to stop monthly periods. Each treatment works for some women but not others. Treatments include:

• Hormones, such as a progestin pill or daily birth control pill (progestin and estrogen). These hormones help control the menstrual cycle and reduce bleeding and cramping.
• Use of the levonorgestrel IUD. It releases a progesterone-like hormone into the uterus.
• Hysteroscopy. This procedure can remove polyps or fibroids.
• Surgery, such as endometrial ablation or hysterectomy. It may be done when other treatments don't work.

If you also have menstrual pain or heavy bleeding, you can take regular doses of a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen.

Doctors may use a wait-and-see approach.

What Increases Your Risk

Risk factors (things that increase your risk) for abnormal uterine bleeding include:

• Your age. Abnormal uterine bleeding is more common in teens, at the beginning of the reproductive years, and in perimenopausal women at the end of their reproductive years.
• Your weight. Overweight women more commonly develop abnormal uterine bleeding.^{footnote 1}

Some women have abnormal uterine bleeding even though they have no risk factors.

Prevention

Sometimes hormonal changes cause abnormal uterine bleeding, so it cannot be prevented. But being overweight can affect your hormone production, which increases your risk for irregular menstrual bleeding. If you are overweight, losing weight may help prevent abnormal uterine bleeding.

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Symptoms

Symptoms of abnormal uterine bleeding include:

• Getting your period more often than every 21 days or farther apart than 35 days. A normal adult menstrual cycle is 21 to 35 days long. A normal teen cycle is 21 to 45 days.
• Periods that last longer than 7 days. (A normal period lasts 4 to 6 days.)
• Bleeding that is heavier than normal. This means blood loss of more than 80 mL (3 fl oz) each menstrual cycle. Normal blood loss is about 30 mL (1 fl oz). If you are passing blood clots and soaking through your usual pads or tampons each hour for 2 or more hours, your bleeding is considered severe and you should call your doctor.

What Happens

Abnormal uterine bleeding may occur from the teen years until after age 40. In teens, it often improves as menstrual cycles get more regular. Some women in their 20s through 40s have abnormal bleeding because of changing hormone levels. Uterine fibroids or polyps also can cause it. The problem goes away with menopause.

When to Call

Any big change in menstrual pattern or amount of bleeding that affects your daily life should be checked by a doctor. This includes menstrual bleeding for three or more menstrual cycles that:

• Occurs more often than every 21 days or farther apart than 35 days. (A normal teen menstrual cycle can last up to 45 days.)
• Lasts longer than 7 days.
• Involves passing blood clots and soaking through your usual pads or tampons each hour for 2 or more hours.

Watchful waiting

Watchful waiting is a wait-and-see approach. If you have been diagnosed with abnormal uterine bleeding, you may consider watchful waiting when:

• A careful examination has revealed no other physical problem or disease.
• Blood loss is not severe enough to cause anemia.
• You prefer to wait and see if your symptoms get better on their own. If you are a teen, you can expect your cycles to even out with time. If you are nearing the age of menopause, you can expect menstrual cycles to stop sometime soon.

Talk to your doctor if you have not had a menstrual period for more than 3 months.

Check your symptoms

Exams and Tests

Before your doctor finds the cause of abnormal uterine bleeding, he or she must first make sure it's not vaginal bleeding from pregnancy or miscarriage.

Your doctor will ask how often, how long, and how much you have been bleeding. (If you can, bring with you a record of the days you had your period, how heavy or light the flow was, and how you felt each day.)

You may also have:

• A pelvic examination.
• A urine test.
• A blood test.
• An ultrasound.
• A Pap smear.
• A biopsy. For this test, your doctor takes a tiny sample of tissue from your uterus.

These tests will help your doctor check for other causes of your symptoms.

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Treatment Overview

Abnormal uterine bleeding usually can be treated with medicine, hormone therapy, or both. Surgery may be done for bleeding that can't be controlled with medicine or hormones.

Acute, severe uterine bleeding

Severe uterine bleeding is most often treated as an emergency with high-dose estrogen. In the rare cases where that doesn't work, a dilation and curettage (D&C) may be done. It can clear the uterus of tissue. When needed, a blood transfusion is used to quickly restore blood volume.

Later, you and your doctor can choose a treatment that is safe for the longer term.

Ongoing uterine bleeding

Your treatment choices depend on your age, the cause of your bleeding, and if you plan to get pregnant in the future.

• If you are a teen, you can expect your periods to become more regular as you get older. You may choose to wait and see if your periods become more regular. If you need treatment, your doctor may prescribe progestin or birth control pills. They can make your cycle regular.
• If you aren't ovulating regularly, it's hard to know how long your bleeding will last until you stop having periods (menopause). Your doctor may give you hormones to make your cycle regular. This may include birth control pills or a hormonal IUD. If you don't plan to get pregnant and your symptoms are severe, you can choose to have surgery. You can choose surgery to remove your uterus (hysterectomy) or to destroy the uterine lining (endometrial ablation).
• If you plan to become pregnant in the future, talk to your doctor about your options. You may take progestin or birth control pills. Or you may have a procedure to remove polyps or fibroids. If you don't plan to get pregnant, you can think about endometrial ablation or hysterectomy if other treatment doesn't help.

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Self-Care

You can use home treatment for some problems related to abnormal uterine bleeding.

For menstrual pain and heavy bleeding, you can use a non-steroidal anti-inflammatory drug (NSAID), such as over-the-counter ibuprofen. An NSAID works best when you start taking it 1 to 2 days before you expect pain to start. If you don't know when your period will start next, take your first dose of an NSAID as soon as bleeding or premenstrual pain starts. Be safe with medicines, and follow your doctor's instructions.

Irregular menstrual bleeding can lead to low levels of iron in the blood. This condition is known as iron deficiency anemia. You can help prevent anemia by increasing the amount of iron in your diet.

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Medicines

Medicines can help stop or reduce bleeding.

They can:

• Reduce blood loss from the lining of the uterus.
• Stop the menstrual cycle or make it more regular by changing hormone levels.

Medicine choices

Several hormone treatments can manage bleeding.

Birth control pills (synthetic estrogen and progesterone).

Daily birth control pills prevent pregnancy. They also reduce the amount of heavy menstrual bleeding by about half.^{footnote 2} But when you stop taking the pills, bleeding may return.

Progestin pills (synthetic progesterone).

In some women, progestins can control growth and bleeding of the uterine lining. You usually take progestins 10 to 12 days every month.

The levonorgestrel intrauterine device (IUD).

A doctor inserts this birth control device into your uterus through your vagina. It stays in your body for up to 5 years. It releases levonorgestrel, a form of progesterone, into the uterus.

Estrogen.

In some severe or urgent cases, estrogen may be used to reduce bleeding.

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Surgery

Surgery may be done to treat bleeding that isn't controlled with medicine.

Surgery choices

Several procedures are used to treat bleeding.

• Hysteroscopy can be used to diagnose and treat bleeding at the same time. A lighted viewing scope is placed through the vagina and cervix and into the uterus. Biopsies can be taken where there is bleeding. The bleeding can be treated with either a laser beam or electric current.
• Hysterectomy is the removal of the uterus. It may be done when a biopsy shows abnormal cell changes or cancer. It also can be done when bleeding can't be controlled or when the cause of long-term bleeding can't be found and treated.
• Endometrial ablation is another choice when other medical treatments don't work or when you or your doctor have reasons for not using other treatments. It scars the uterine lining, so it is not an option if you are planning to become pregnant.

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