Abnormal Uterine Bleeding

Types of Abnormal Uterine Bleeding

Many types of uterine bleeding can be considered abnormal, including:

• Bleeding or spotting between menstrual periods.
• Unusually heavy bleeding during your period.
• Periods that last longer than seven days.
• Bleeding after menopause.

Abnormal bleeding is most common in young girls who just started having periods and women who are in perimenopause (usually starting in their early 40s). Periods can be irregular during these times, with shorter or longer cycles and lighter or heavier than usual bleeding. Even though these changes are common, you should still talk with a healthcare provider if you are experiencing any abnormal bleeding.

Common Causes of Abnormal Bleeding

• Adenomyosis: A condition in which the endometrium grows into the uterine wall.
• Clotting/bleeding disorders: If you have a condition in which your blood doesn’t clot properly, it can cause heavy bleeding during your period.
• Fibroids and polyps: Non-cancerous growths found in the uterus or cervix.
• Birth control: Hormonal birth control can cause changes to menstrual bleeding, as well as breakthrough bleeding between periods. The copper intrauterine device (IUD) can also cause heavier menstrual bleeding.
• Medications: Medications such as blood thinners and aspirin can cause heavier than usual menstrual bleeding.
• Ovulation irregularities: Lack of ovulation can lead to a thicker than usual endometrium (lining of the uterus), causing irregular or heavy menstrual bleeding. Cycles in which you do not ovulate are more common in girls who have recently started menstruating, perimenopausal women and women with certain medical conditions such as polycystic ovary syndrome (PCOS).
• Other causes, such as endometriosis, pelvic inflammatory disease (PID) and pregnancy-related causes.

Diagnosing Abnormal Uterine Bleeding

If you are experiencing abnormal uterine bleeding, your healthcare provider can perform an evaluation to help determine the cause of your bleeding and discuss your treatment options.

Your evaluation may include:

• Physical exam, including a pelvic exam: Your provider will look for any abnormalities of your reproductive organs, which include the vagina, uterus, ovaries and cervix.
• Lab tests: Blood tests to check for conditions such as anemia, bleeding disorders, infections or sexually transmitted infections (STIs).
• Ultrasound: Uses sound waves to view your cervix, uterus, ovaries and other pelvic organs.
• Hysteroscopy: A small scope and camera is inserted through the vagina and cervix so your provider can view the uterus.
• Sonohysterography: Fluid is placed in the uterus through a thin plastic tube, then ultrasound waves are used to create images of the uterus.
• Other imaging tests: Including magnetic resonance imaging (MRI) or computed tomography (CT) scans.
• Biopsy: Your provider may collect a sample of endometrial tissue to be examined in a lab.

Treatment for Abnormal Uterine Bleeding

Treatment options for abnormal uterine bleeding depend on many factors, including the type, cause and severity of the bleeding and your personal medical history.

Medications

Medication is usually tried first before more invasive options such as surgery. Medications used to manage abnormal uterine bleeding include:

• Hormonal birth control, including birth control pills, hormonal intrauterine devices (IUDs), vaginal rings, birth control patch, and birth control injections. Hormonal birth control options include combination methods (which contain both estrogen and progestin) and progestin-only methods. Depending on the type, hormonal birth control can help regulate menstrual bleeding, lighten heavy periods, reduce the number of periods you have or stop them completely.
• Hormone therapy: Often used by women in perimenopause, hormone therapy can help treat heavy menstrual bleeding and also addresses perimenopause symptoms such as hot flashes, night sweats and vaginal dryness. Periods can become lighter and more regular when using hormone therapy.
• Gonadotropin-releasing hormone (GnRH) agonists: This type of drug can be taken for short periods of time and can stop the menstrual cycle and temporarily reduce the size of fibroids.
• Tranexamic acid: A prescription medication that is used to reduce heavy periods.
• Blood-clotting medications: Can be used in patients who have a bleeding disorder.

Additional medications include antibiotics if the abnormal bleeding is due to an infection and nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, to help control heavy menstrual bleeding and relieve cramps.

Surgery

If medication doesn’t stop abnormal uterine bleeding, surgery may be necessary. The type of procedure will depend on many factors, such as your age and the condition causing the bleeding.

• Hysterectomy: Surgery to remove the uterus can treat fibroids and adenomyosis. Women who opt for hysterectomy will no longer be able to get pregnant.
• Myomectomy: This procedure removes fibroids while keeping the uterus intact, preserving the woman’s fertility.
• Uterine artery embolization: With this procedure, the arteries supplying a fibroid with blood are blocked off with small plastic particles injected through a catheter. This will help shrink the fibroids.
• Endometrial ablation: This procedure destroys the lining of the uterus and can reduce the total amount of bleeding or stop menstrual bleeding completely. This procedure is reserved for women who do not wish to become pregnant. Women most likely will not be able to get pregnant after the procedure, but if they do it can cause serious complications. It is important for women to use reliable birth control after endometrial ablation.