Abnormal Menstrual Bleeding

What is abnormal bleeding?

If you have abnormal bleeding, you may experience uterine bleeding between your menstrual periods or excessively during your menstrual periods. A typical menstrual flow lasts for about five days. If you experience bleeding for longer than seven days per month, or if your periods are very irregular – shorter than 21 days or longer than 35 days – you also have abnormal uterine bleeding. Abnormal bleeding may or may not come with other symptoms, including:

• Dysmenorrhea (pelvic pain with menstruation)
• Bloating
• Breast tenderness

You should contact your doctor for an appointment for any kind of abnormal uterine bleeding. It’s especially urgent if you soak through your pads every hour or if you feel dizzy or faint due to the loss of blood.

What causes abnormal bleeding?

There are many health conditions that can cause abnormal bleeding, so you should get a thorough evaluation that might include diagnostic testing. A few of the most common causes are:

• Endometriosis
• Polycystic ovary syndrome (PCOS)
• Uterine fibroids
• Uterine polyps
• Early pregnancy
• Sexually transmitted infections (STIs)
• Hormonal birth control and other medications
• Menopause complications

PCOS, one of the most common causes, is a condition that occurs when you have excess androgen levels, or male hormones. Many women with PCOS develop cysts in their ovaries because of the hormonal imbalance. It can cause you to grow extra hair on your face or body, and you may struggle to get pregnant.

How is abnormal bleeding diagnosed?

To diagnose your abnormal uterine bleeding, your specialist investigates the characteristics of your abnormal uterine bleeding. Questions about the possibility of a pregnancy and whether or not you have any other symptoms outside of the bleeding will be asked. Next, your doctor gives you a comprehensive pelvic examination. A Pap smear might be performed to test the cells of your cervix for abnormal characteristics. You may also need:

• Pregnancy test
• Thyroid test
• Blood tests
• Pelvic ultrasound

If you’re over 35, have a family history of certain complications, or are at risk for cancer, your provider might recommend an endometrial biopsy. During this test, they take a cell sample from the lining of your uterus and examine it under a microscope. They can test the endometrium for hormone imbalance, endometrial cancer, and other complications leading to abnormal bleeding.

How is abnormal bleeding treated?

After your doctor diagnoses you, a treatment plan can be formulated, according to the cause of your bleeding. Treating abnormal bleeding often involves hormonal treatments like hormonal birth control or progestin shots.
For structural abnormalities like polyps and fibroids, you might need minimally invasive surgery to remove them. Your doctor may recommend procedures like dilation and curettage or endometrial ablation to remove the uterine lining and treat your abnormal bleeding. More extreme options, like hysterectomy, are often a last-resort treatment for abnormal bleeding.