Abnormal uterine bleeding can describe bleeding that is longer than usual, occurs at odd times or is heavier or lighter than what is normal for you.

It can occur at any age and could be an indication of many conditions. Abnormal uterine bleeding is more common with teenagers or those who are premenopausal. Being overweight also may increase the likelihood of irregular bleeding.

If the following happens to you, the American College of Obstetricians and Gynecologists recommends you consult with your OB/GYN:

• Bleeding or spotting between periods or after sex
• Heavy menstrual bleeding — more than seven days or soaking through a tampon or pad every hour or less
• Menstrual cycles that last more than 35 days or less than 21 days
• Menstrual cycles that vary in length by more than seven to nine days
• No period for three to six months
• Bleeding after menopause

Abnormal uterine bleeding and chronic pelvic pain are two separate conditions, but many times appear at the same time.

In many patients, abnormal uterine bleeding is caused by alterations in ovulation and hormonal levels. Stress, thyroid disorders, polycystic ovary syndrome and weight changes can be risk factors for hormone-related irregular bleeding patterns and abnormal uterine bleeding.

In many cases, your primary care provider or OB/GYN can treat abnormal bleeding with nonhormonal medications or hormone therapy, which can include birth control pills, injections, or an intrauterine device (IUD). There are also several outpatient procedures that can help improve symptoms effectively. In cases where surgery is required, choose a Center of Excellence in Minimally Invasive Gynecology.

This certification, which has been given to Norton Women’s & Children’s Hospital, recognizes minimally invasive gynecologic surgery programs that are focused on improving the safety and quality of gynecologic patient care and are designed to expand access to minimally invasive gynecologic procedures performed by surgeons.

At Norton Women’s Care, we are committed to achieving high standards in safe, quality care for those who need minimally invasive gynecologic surgery. Our fellowship-trained and board-certified minimally invasive gynecologic surgeons are at the forefront of new discoveries and perform many procedures with only a few small incisions — procedures that traditionally required a large abdominal incision.

Causes of Abnormal Uterine Bleeding

• Abnormal hormone levels. Issues with ovulation can result in hormonal imbalances that directly affect the inside lining of the uterus, resulting in irregular or heavy periods.
• Uterine fibroids. A uterine fibroid is a benign tumor that arises from the muscle tissue in the uterus. As they grow larger, they can interfere with the uterine lining and the uterus’s ability to effectively contract, which results in very heavy menstrual cycles and irregular bleeding patterns.
• Polycystic ovary syndrome. This common hormonal disorder can disrupt the menstrual cycle, leading to dysfunctional uterine bleeding.
• Uterine polyps. Uterine polyps are small growths of tissue arising from the inside lining of the uterus. Symptoms usually include bleeding after intercourse, irregular bleeding patterns and unpredictable cramping.
• Adenomyosis. This is a condition where the uterine lining grows into the uterus’s muscular wall. The result can be abnormal bleeding, pelvic pain and painful periods. A common risk factor for developing this is history of cesarean birth.
• Endometrial hyperplasia. This can be a type of “precancer” of the uterine lining caused by over-exposure to certain hormones. It can be diagnosed in the office via a simple biopsy.
• Endometrial cancer. One reason to have abnormal uterine bleeding checked out is to rule out endometrial cancer. If further testing is required, an endometrial biopsy may be performed to collect a sample of tissue for examination by a pathologist.
• Pregnancy or medication-related complications. Ectopic pregnancy or miscarriage can cause heavy bleeding. Some medications can affect clotting and contribute to abnormal bleeding.

Abnormal Uterine Bleeding Treatment Options

Treatment options for your bleeding will depend on the underlying cause. Common treatments include:

• Medications. Hormone therapy, including birth control pills and progestin therapy, can help regulate menstrual cycles.
• Minimally invasive procedures. Endometrial ablation or uterine artery embolization target the lining of the uterus or its blood supply. Increasingly, uterine fibroids or polyps can be removed through minimally invasive procedures.

Reviewed by Steven J. Radtke, M.D., FACOG, FMIGS, gynecologic surgeon with Norton Women’s Care.