How will the cause of my abnormal uterine bleeding be diagnosed?

Diagnosis begins with a discussion of your symptoms and a complete personal and family medical history, followed by a pelvic exam and Pap test as well as a general assessment of your overall health.

How is abnormal bleeding treated?

Depending on the cause, abnormal bleeding may be treated with medications to balance hormones including birth control pills and bioidentical hormones, treatment of underlying conditions such as thyroid disease, or minimally invasive procedures to remove fibroids, remove the lining of the uterus, manage endometriosis or treat other conditions.

Abnormal Uterine Bleeding

Q: What is abnormal uterine bleeding?

Itis considered to be bleeding that occurs outside of the typical pattern of a normal menstrual cycle, which typically occurs about every 28 days and lasts for about five to seven days.

Q: What causes abnormal uterine bleeding?

Often, abnormal bleeding occurs as a result of hormonal fluctuations during perimenopause, the months and years preceding menopause, or the end of periods. Other times, abnormal bleeding may occur as a result of endometriosis, uterine fibroids, PCOS, miscarriage, pregnancy, thyroid disease, significant fluctuations in weight, prolonged strenuous physical activity, chronic stress, changes in birth control pills and breastfeeding.

In this article, we’ll delve into the common causes of AUB, often called abnormal uterine bleeding, ranging from hormonal imbalances to structural abnormalities. We’ll explore the symptoms to watch for, including heavy menstrual bleeding and bleeding between periods.

If you’re experiencing irregularities in your menstrual period, it’s essential to seek help. Consider scheduling an appointment with Maiden Lane Medical, a trusted gynecology practice in New York City. Don’t hesitate to visit our new walk-in clinic located in Murray Hill, NY, for personalized care and support.

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What is Abnormal Uterine Bleeding?

Abnormal uterine bleeding refers to any unusual bleeding from the uterus that doesn’t follow a typical menstrual cycle pattern. This can include heavy bleeding, bleeding between periods, or periods that last longer than usual to name a few.

Is Abnormal Uterine Bleeding Common?

Abnormal uterine bleeding is relatively common, affecting many individuals at some point in their lives. Heavy menstrual bleeding, a type of abnormal bleeding, is one of the most frequent gynecological complaints. It can disrupt daily activities and impact quality of life.

What Causes Abnormal Uterine Bleeding?

Abnormal uterine bleeding can stem from various factors, including hormonal imbalances, structural abnormalities, and underlying medical conditions.

Hormonal Imbalances: Fluctuations in hormone levels, such as estrogen and progesterone, can disrupt the normal menstrual cycle, leading to abnormal bleeding. This imbalance may occur due to factors like stress, thyroid disorders, or obesity.
Structural Abnormalities: Conditions affecting the uterus, such as fibroids (noncancerous growths), polyps (abnormal tissue growth), or adenomyosis (when the lining of the uterus grows into the muscle wall), can cause irregular bleeding.

Additional causes for abnormal bleeding could include:

Birth Control Pills: Some individuals may experience abnormal bleeding as a side effect of birth control pills, especially during the initial months of usage. Adjusting the type or dosage of contraceptive pills can often resolve this issue.
Polycystic Ovary Syndrome (PCOS): PCOS is a hormonal disorder characterized by irregular periods, ovarian cysts, and elevated levels of male hormones. It can lead to abnormal uterine bleeding due to irregular ovulation and hormonal imbalances.
Bleeding Disorders: Conditions such as von Willebrand disease or platelet function disorders can impair blood clotting, leading to heavy or prolonged menstrual bleeding.
Medical Conditions: Certain medical conditions like endometriosis (when tissue similar to the lining of the uterus grows outside the uterus), pelvic inflammatory disease and STI or infections, thyroid disorders, and rarely cancers can contribute to abnormal uterine bleeding.
Pregnancy and Pregnancy Complications: Miscarriage, ectopic pregnancy (when a fertilized egg implants outside the uterus), or complications with the placenta during pregnancy can cause abnormal bleeding.

What Are Some Abnormal Bleeding Symptoms?

Recognizing the symptoms of abnormal vaginal bleeding is essential for understanding when to seek medical attention. Here are some common signs to watch for:

Heavy Menstrual Bleeding: Experiencing periods with unusually heavy flow, requiring frequent changes of pads or tampons within a short time, may indicate abnormal vaginal bleeding.
Bleeding Between Periods: Any bleeding that occurs outside of the regular menstrual cycle is considered abnormal. This could manifest as spotting or bleeding between periods, or even as post-coital bleeding.
Unusual Uterine Bleeding: Bleeding that differs significantly from your typical menstrual pattern, such as sudden changes in flow or duration, should be noted. Pay attention to any bleeding that seems abnormal for your body.
Bleeding After Menopause: Any vaginal bleeding that occurs after menopause, when periods have ceased for at least 12 consecutive months, is considered abnormal and requires immediate medical evaluation.
Pain Accompanied by Bleeding: Severe abdominal or pelvic pain, along with abnormal vaginal bleeding, could indicate an underlying issue that needs medical attention.
Blood Clots: Passing large blood clots during menstruation or experiencing clotting outside of menstruation may indicate abnormal vaginal bleeding.

It’s crucial to remember that every person’s menstrual cycle is unique, and what is normal for one person may be abnormal for another.

However, if you experience any of these symptoms consistently or if they significantly disrupt your daily life, it’s essential to consult with a healthcare provider. They can help diagnose the underlying cause of the abnormal vaginal bleeding and recommend appropriate treatment options. A general rule of thumb is that bleeding that is heavier or more painful than your normal menses may be abnormal.

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How is Abnormal Uterine Bleeding Diagnosed?

Diagnosing abnormal uterine bleeding typically involves a combination of medical history assessment, physical examination, and diagnostic tests. Here’s how it’s commonly done:

Medical History: Your healthcare provider will ask about your menstrual cycles, including the frequency, duration, and intensity of bleeding. They’ll also inquire about any recent changes in your menstrual flow or any other symptoms you may be experiencing.
Physical Examination: A pelvic exam may be performed to check for any abnormalities in the reproductive organs, such as fibroids, polyps, or signs of infection. Your healthcare provider may also conduct a general physical exam to assess your overall health.
Lab Tests: Blood tests may be ordered to check for conditions like anemia (low red blood cell count) or hormonal imbalances, which can contribute to abnormal uterine bleeding.
Imaging Tests: Ultrasound imaging, such as transvaginal ultrasound, may be used to visualize the uterus and ovaries to identify any structural abnormalities or conditions like fibroids or polyps.
Endometrial Biopsy: In some cases, a small sample of tissue from the lining of the uterus (endometrium) may be collected for examination under a microscope. This procedure, called an endometrial biopsy, can help diagnose conditions like endometrial hyperplasia or cancer.
Hysteroscopy: A hysteroscopy involves inserting a small camera through the cervix to examine the inside of the uterus. This procedure can help detect abnormalities such as polyps, fibroids, or other issues affecting the uterine lining.

By combining these diagnostic methods, healthcare providers can effectively identify the underlying cause of abnormal uterine bleeding.

Abnormal Uterine Bleeding Treatment

Treating abnormal uterine bleeding depends on the underlying cause and individual needs. Here are common treatment approaches:

Medications: Hormonal medications, such as birth control pills or hormone therapy, are often prescribed to regulate menstrual periods and reduce abnormal bleeding. Certain nonsteroidal anti-inflammatory drugs (NSAIDs) may also help alleviate pain and reduce bleeding during menstrual periods.
Endometrial Ablation: This minimally invasive procedure involves destroying the lining of the uterus to reduce or stop menstrual bleeding. It’s often recommended for individuals who have completed childbearing and prefer a non-hormonal option.

Additional treatments for abnormal bleeding could include:

Uterine Fibroid Embolization (UFE): UFE is a procedure that involves blocking the blood supply to uterine fibroids, leading to their shrinkage and reduced bleeding. It’s a less invasive alternative to larger surgeries for managing heavy menstrual bleeding caused by fibroids.
Surgical Procedures: In cases where conservative treatments are ineffective or not suitable, surgical interventions may be considered. Procedures like hysterectomy (removal of the uterus) or myomectomy (removal of fibroids) may be recommended to address underlying issues causing abnormal uterine bleeding.
Lifestyle Changes: Making lifestyle modifications such as maintaining a healthy weight, exercising regularly, and managing stress can help regulate menstrual periods and reduce the severity of abnormal bleeding.

Seeking Help for Abnormal Uterine Bleeding

If you’re experiencing irregularities in your menstrual period, don’t hesitate to seek help. Abnormal uterine bleeding can be disruptive and may indicate underlying health concerns.

Take charge of your reproductive health and schedule an appointment with Maiden Lane Medical today! Also, feel free to visit our new Walk-in Gynecology & Women’s Care clinic, conveniently located in Murray Hill, New York. Your well-being matters and proactive management of abnormal uterine bleeding can lead to a happier, healthier you!

Medically Reviewed By

Fernando Mariz, MD

Obstetrics and Gynecology

Women's Health Specialists

Rachel Barr, MD

Emily Blanton, MD

Janette Davison, MD

Ilene Fischer, MD

Dena Harris, MD

Kenneth A. Levey, MD MPH FACOG FACS

Fernando Mariz, MD

Jordan Pavia, NP

Savita Sukha, WHNP

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