Abnormal Uterine Bleeding – Causes, Symptoms, Diagnosis, And Treatment
What is abnormal uterine bleeding?
Abnormal uterine bleeding (AUB) refers to heavy or unusual bleeding from the uterus. Bleeding may be heavier or lighter than usual, longer than usual, may occur between periods. It may be prolonged, frequent, or random. AUB may also occur after menopause.
AUB is more common in teenagers or in premenopausal women. Women who are overweight also may be more likely to have AUB.
What causes abnormal uterine bleeding?
Anovulation (ovaries not releasing an egg) and hormonal imbalance are the most common causes of abnormal uterine bleeding.
In most women, female hormone levels change every month. The hormones estrogen and progesterone are released as part of the process of ovulation. When a woman ovulates, an egg is released. Abnormal uterine bleeding can occur when the ovaries do not release an egg (anovulation). Changes in hormone levels cause your period to be later or earlier. Your period may sometimes be heavier than normal.
The following are the common causes of AUB:
- Problems with ovulation
- Thickening of the uterine wall or lining
- Uterine polyps
- Uterine fibroids
- Cancers of ovaries, uterus, cervix, or vagina
- Bleeding disorders or problems with blood clotting
- Polycystic ovary syndrome
- Severe weight loss
- Hormonal birth control, such as birth control pills or intrauterine devices (IUD)
- Excessive weight gain or loss (more than 10 pounds or 4.5 kilograms)
- Infection of the uterus or cervix
- Ectopic pregnancy
What are the symptoms of abnormal uterine bleeding?
The following are the symptoms of abnormal uterine bleeding:
- Bleeding or spotting from the vagina between periods
- Periods that occur less than 28 days apart (more common) or more than 35 days apart
- The time between periods changes each month
- Heavier bleeding (such as passing large clots, needing to change protection during the night, soaking through a sanitary pad or tampon every hour for 2 to 3 hours in a row)
- Bleeding that lasts for more days than normal or for more than seven days
The following are the other symptoms that may occur due to changes in hormone levels:
- Hot flashes
- Mood swings
- Tenderness and dryness of the vagina
- Hirsutism (excessive growth of body hair in a male pattern)
How is abnormal uterine bleeding diagnosed?
The doctor will review the symptoms and history of the menstrual cycle in detail, and perform a pelvic exam.
The doctor may order the following tests to rule out any blood disorder and other causes:
- Pap smear
- Complete blood count (CBC)
- Blood clotting profile
- Liver function tests (LFT)
- Fasting blood glucose
- Hormone tests, for FSH, LH, male hormone (androgen) levels, prolactin, and progesterone
- Pregnancy test
- Thyroid function tests
Your doctor may order the following tests for diagnosis of AUB:
- Culture to look for infection
- Biopsy to check for precancer, cancer, or to help decide on hormone treatment
- Hysteroscopy, performed in your provider’s office to look into the uterus through the vagina
- Ultrasound to look for problems in the uterus or pelvis
How is abnormal uterine bleeding treated?
The doctor may recommend the following treatments for abnormal uterine bleeding:
- Low-dose birth control pills
- Hormone therapy
- High-dose estrogen therapy for women with very heavy bleeding
- Intrauterine device (IUD) that releases the hormone progestin
- Nonsteroidal anti-inflammatory drugs (NSAID) taken just before the period starts
If the medications don’t stop the bleeding or if cancer is diagnosed, surgery may be needed.
The doctor may recommend the following procedures:
- Uterine artery embolization (a procedure to treat fibroids).
- Surgery, if the cause of the bleeding is a polyp or fibroid
- Myomectomy (a surgical procedure to remove the fibroids leaving the uterus intact).
- Endometrial ablation (a surgical procedure to destroy the lining of the uterus)
- Hysterectomy (a surgical procedure to remove the uterus)
This feature is for informational purposes only and is not intended to substitute the expert guidance of a doctor. We advise seeing a doctor if you have any health concerns.