About Abnormal Uterine Bleeding

The menstrual period is the time during a woman's cycle when bleeding occurs. Bleeding may last up to seven days. When the menstrual cycle is not regular, bleeding lasts longer or is heavier than normal, or bleeding occurs between periods, it is known as abnormal uterine bleeding.

About The Menstrual Cycle

The menstrual period begins with the first day of the bleeding of one period and ends with the first day of the next period. An average menstrual cycle lasts about 28 days.

Causes of Abnormal Uterine Bleeding

It is normal for menstrual periods to be irregular at certain times of life. For the first few years after a girl begins to have periods (around age 9 to 16), they are often irregular. As women approach menopause (around the age of 50), their periods once again may become irregular. Menstrual cycles that are longer than every 35 days (bleeding too seldom) or shorter than every 21 days (bleeding too often) are not normal. Women with such cycles should be checked by a doctor.

Abnormal or heavy uterine bleeding may occur because of hormonal problems. The most common result of a hormone imbalance is anovulation — when the ovaries do not release an egg and a woman does not have a period. Anovulation may occur if the ovaries produce too much androgen — a male hormone. Often, when anovulation occurs, the ovaries develop many cysts. This condition is known as polycystic ovary syndrome.

Diagnosis for Abnormal Uterine Bleeding

To diagnose abnormal uterine bleeding, your doctor will obtain a history of your health. It is helpful for you to keep track of the dates and length of your periods by marking them on a calendar.

Your doctor also will do a physical exam. You may have blood tests to check your blood count and hormone levels and to see if you are pregnant. Other tests may be needed based on your symptoms.

About Polycystic Ovary Syndrome (PCOS)

Symptoms of polycystic ovary syndrome include:

  • Irregular uterine bleeding
  • Irregular periods from an early age
  • Infertility
  • Acne
  • Excessive facial hair or hair on the abdomen or chest

Other causes of abnormal uterine bleeding include medications, other hormonal conditions, fibroids, uterine polyps and other anatomic conditions, coagulopathy, and pregnancy.

 

Treatments for Abnormal Uterine Bleeding

Ultimately the best treatment for abnormal uterine bleeding depends on the cause and your goals, so you should work with your doctor to find the best treatment for you. Some options are below.  

Hormone therapy

Estrogen-progestin contraceptives are usually first-line management. The advantages of estrogen-progestin contraceptives are that they typically make bleeding more regular, lighter, and reduce dysmenorrhea, as well as provide contraception. If someone is unable to take or prefers to avoid estrogen, progesterone-only therapies are a reasonable approach as well. These include oral progesterone, the progesterone shot, or the progesterone IUD, among others. These generally reduce menstrual blood flow and sometimes stop flow entirely, however a disadvantage is they often initially result in irregular menses. The progesterone IUD’s advantage is that the hormone generally acts locally, minimizing any progesterone related side effects.  

Nonhormonal therapy

NSAIDs (eg ibuprofen) or tranexamic acid are non-hormonal medications that can be used to reduce menstrual blood flow. These are only taken during one’s menses.

Endometrial Ablation

Endometrial ablation offers an effective alternative to hysterectomy for patients suffering from heavy or prolonged bleeding during their period. It is often chosen when other medical treatments have failed or are otherwise undesirable. This procedure involves the removal of the lining of the uterus, which is the source of the bleeding. According to recent studies, most women feel that endometrial ablation relieves the problem with their period. Up to 90% of women who have this procedure are satisfied with the results. After the procedure, the women who were satisfied with it reported lighter periods or normal periods. Some women said that their periods stopped completely after endometrial ablation. Read more about Endometrial Ablation.

Hysterectomy

Removal of the uterus also may be used to treat abnormal uterine bleeding. Click to read more about hysterectomy options.

Finally ...

If you notice that your cycles have become irregular, you should see your doctor. Abnormal uterine bleeding has a number of causes. There is no way of telling why your bleeding is abnormal until your doctor examines you. Once the cause is found, abnormal uterine bleeding often can be treated with success.

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