Abnormal Uterine Bleeding: When To Worry

For most women, routine uterine bleeding is normal and not a cause for concern. When anything changes, like a different cycle length, heavier bleeding or bleeding when you shouldn’t, you need medical attention.

Any bleeding that’s unusual for you is called abnormal uterine bleeding. That includes irregular periods. Abnormal uterine bleeding can happen for many reasons, so it’s important to talk with your doctor. Based on the cause, several treatments can reduce or stop your bleeding.

Here, Roman Puliaev, MD, an obstetrician-gynecologist with Franciscan Physician Network, explains abnormal uterine bleeding, why it happens and treatment options.

Key Takeaways: Irregular Periods And Abnormal Bleeding

• An underlying health problem may cause irregular periods.
• Bleeding after menopause may indicate tumor growth, including cancer.
• Abnormal uterine bleeding can be treated with medication or surgery.

What Is Abnormal Uterine Bleeding?

Abnormal uterine bleeding, also called menometrorrhagia, is any bleeding that’s out of the ordinary for you. You may bleed between your regular monthly cycle. Or your period could be longer or heavier than usual.

Doctors estimate 10 percent to 35 percent of females experience abnormal uterine bleeding. But the numbers could be higher because many people don’t report their symptoms. Abnormal uterine bleeding usually happens any time between your first period and perimenopause. But it can also occur after menopause.

What Is An Irregular Period?

An irregular period is a specific type of abnormal uterine bleeding, Dr. Puliaev said. Most menstrual periods last between four and seven days. The average menstrual cycle is 28 days but can range from 21 days to 35 days.

You may have irregular periods if you have:

• A menstrual cycle shorter than 21 days or longer than 35 days.
• Heavy menstrual bleeding that interferes with your daily activities. For example, you may change pads or tampons every few hours or frequently use them together for “double protection.”
• Menstrual bleeding that lasts longer than seven days.

What Causes An Irregular Period?

According to Dr. Puliaev, certain health conditions, hormone changes, medications or stress can cause an irregular period. If you’re experiencing abnormal bleeding, your doctor can help you figure out why.

Causes of your irregular period may include:

• Bleeding or clotting disorder
• Certain medications, like blood-thinners that treat heart conditions
• Endometriosis
• Extreme exercise
• Fibroids or polyps (tissue growths)
• Gynecologic cancers (ovarian or uterine cancer)
• Obesity
• Pelvic inflammatory disease (PID)
• Perimenopause
• Polycystic ovarian syndrome (PCOS)
• Precancerous lesions in the uterus lining the
• Stress
• Thyroid disease
• Weight gain or loss

What Causes Abnormal Uterine Bleeding After Menopause?

If you haven’t had a period in the last 12 months, you’ve gone through menopause. Any bleeding you have post-menopause is unusual and should be evaluated by your doctor.

In most cases, the cause of the bleeding is not cancerous. A breakdown of your uterine lining can cause bleeding. Or a uterine fibroid or polyp could be to blame. Your doctor can diagnose you with a pelvic exam or an ultrasound.

However, precancerous lesions or gynecologic cancer, like endometrial cancer, can also be the root of your problem.

“Endometrial cancer can cause around 10 percent of postmenopausal bleeding,” Dr. Puliaev said. “Therefore, it’s essential that any woman — especially those who have gone through menopause — see a doctor for bleeding that is unusual for them.”

What Are The Risks Of Abnormal Uterine Bleeding?

Abnormal uterine bleeding can disrupt your daily routine and keep you from the activities you enjoy most. It can also cause other health problems if you don’t get the treatment you need, Dr. Puliaev said.

Complications from abnormal uterine bleeding depend on how heavy your bleeding is and why it’s happening. Some common problems include:

• Anemia (low red blood cell count due to blood loss)
• Chest pain
• Fatigue
• Shortness of breath during exercise

But you can also experience more severe health issues. Endometriosis and uterine fibroids can cause severe pain. Uterine fibroids and PCOS can also cause fertility problems. And if you don’t ovulate regularly, the lining of your uterus may thicken and continue to grow.

“Properly regulated menstrual cycles allow the endometrial lining to shed each month,” Dr. Puliaev said. “Not shedding that lining could eventually lead to precancerous lesions.”

Along with effects on your physical health, abnormal uterine bleeding can also impact your emotional well-being. It may cause anxiety, depression and stress, decreasing your overall quality of life.

How Is Abnormal Uterine Bleeding Diagnosed?

To diagnose the cause of your abnormal uterine bleeding, your doctor will ask you several questions. They may also recommend blood tests or imaging exams.

Tell your doctor how often you bleed, how heavy it is and what may trigger it. Share your symptoms and discuss any medications or supplements you take. If you can, track your bleeding for several weeks before your doctor’s appointment.

Based on this information, your doctor may suggest any of these tests:

• Blood test: These tests can check your complete blood count and hormone levels and determine how well your blood clots.
• Endometrial biopsy: This small tissue sample from your uterine lining can reveal signs of cancer or pre-cancer.
• Pelvic ultrasound: This imaging exam can show fibroids, polyps and tumors in your uterine lining.

What Are The Treatment Options For Abnormal Uterine Bleeding?

Getting the treatment you need can reduce or stop your bleeding. It can also help you avoid other health complications.

Your doctor will choose the best treatment for you based on the underlying cause of your bleeding, Dr. Puliaev said. Based on your needs, they may recommend:

• Birth control: Birth control medications can regulate your bleeding. These medications may contain progesterone or a combination of progesterone and estrogen. You can choose a pill, patch, injection or intrauterine device (IUD).
• Endometrial ablation: This surgery uses heat to destroy the lining of your uterus and stop abnormal bleeding.
• Hysterectomy: This minimally invasive, laparoscopic surgery removes your uterus. We may recommend this procedure if you aren’t concerned about becoming pregnant in the future.
• Other surgeries: We can surgically remove fibroids and polyps. We can also cut off blood supply to fibroids with uterine fibroid embolization.

Lifestyle changes can help reduce or control your bleeding. Your doctor may suggest these behaviors:

• Exercise: Physical activity can lower your body weight and boost your mental health. Aim for 30 minutes of exercise five days a week.
• Maintain a healthy weight: Talk with your doctor about a healthy weight for you. Dr. Puliaev said losing weight can help regulate your periods and improve your fertility.
• Manage stress: Stress triggers your body to release cortisol and adrenaline. These hormones interfere with your body’s production of estrogen and progesterone, the hormones you need for regular periods. Try meditation, yoga or other relaxation activities to lower your stress level.

If you’re concerned about abnormal uterine bleeding, don’t delay. Talking to a doctor can improve your quality of life. Schedule an appointment with a Franciscan Health OBGYN.