In women with normal uterine bleeding, the average menstrual cycle runs for 21 to 35 days and they experience blood loss for up to seven days. The average amount of blood loss is 2 to 3 tablespoons, or about 1.5 ounces. When women lose more than 2.8 ounces of blood during a monthly cycle or bleed for longer than seven days, it is considered abnormal bleeding.

There are a number of types of abnormal bleeding, but abnormal uterine bleeding (AUB) is the umbrella term for bleeding problems that occur in the uterus. Women with AUB may experience issues with the regularity of bleeding, amount of blood loss, frequency, and duration.

A woman can experience AUB at any age, but the condition is more common throughout certain stages of her life, including:

• The first few years after starting her period
• During perimenopause, the years that the ovaries gradually stop working and menopause occurs
• After menopause

AUB is concerning at any age, and there is no need for a woman to try to get through it on her own. In fact, ignoring the condition can lead to life-threatening health issues. About 30% of women will experience abnormal uterine bleeding (AUB) at some time. Women can find relief through a variety of treatment methods by speaking with their primary care doctor or gynecologist. While pregnancy is outside the scope of AUB, pregnant women who experience abnormal bleeding should contact their doctors as well.

Symptoms of Abnormal Uterine Bleeding

Identifying the symptoms of AUB can help women decide when to contact their doctors. The following types of bleeding are signs of AUB:

• Menstrual bleeding that soaks through one or more menstrual hygiene products every hour
• Menstrual bleeding that lasts for longer than a week
• Extremely short or long menstrual periods — less than 21 days or more than 35 days
• Irregular menstrual cycles that vary in length by more than seven to nine days
• Absence of a period for three to six months
• Menopausal bleeding
• Bleeding or spotting after intercourse
• Bleeding or spotting between periods

Causes of Abnormal Uterine Bleeding

To identify, diagnose and treat AUB conditions, as well as possible underlying causes, the American College of Obstetricians and Gynecologists recommends using the

• Benign tumors that develop when cells in the uterine lining multiply rapidly.
• Cells from the uterine lining grow into the uterine wall.
• Fibroids, which are benign tumors, form in the muscle tissue of the uterus.
• Malignancy and hyperplasia. The uterine lining becomes abnormally thick. This may be referred to as endometrial hyperplasia and can sometimes lead to uterine cancer.
• A condition that reduces the body’s blood-clotting abilities.
• Ovulatory dysfunction. This is a leading cause of abnormal bleeding and occurs when ovulation is faulty, irregular, or nonexistent. Anovulatory bleeding affects up to 33% of women in their childbearing years. In polycystic ovary syndrome, the ovaries create an excess male sex hormones, known as androgens, causing irregular bleeding.
• Relating to problems with the endometrial tissue, such as endometrial cancer. 90% of women with endometrial cancer experience AUB.
• Birth control pills or other medicines contribute to heavy bleeding or irregular bleeding. Hormonal birth control methods and copper intrauterine devices (IUDs) might also cause heavy menstrual bleeding
• Not otherwise classified. Physicians are unable to pinpoint the cause.

Diagnosing Abnormal Uterine Bleeding

To start the diagnosis process for AUB, a gynecologist will ask questions about a patient’s :

• Current and prior medical conditions
• Recent surgeries
• Pregnancies
• Use of over-the-counter and prescription drugs
• Preferred form of contraception
• Frequency of menstrual cycles
• Duration of periods
• Average blood loss amounts
• Frequency of spotting
• Family history

Physicians often perform pelvic exams and complete blood count tests to help diagnose AUB. They may also ask patients to undergo testing for certain bleeding disorders, pregnancy, and sexually transmitted infections. Depending your age and symptoms, doctors might also order other tests:

• Ultrasound. Uses sound waves to create an image of the reproductive system.
• Hysteroscopy. The doctor inserts a thin, illuminated scope into the vagina and through the cervix to view the uterus.
• Endometrial biopsy. This entails taking a small tissue sample for microscopic examination.
• Sonohysterography. The doctor inserts a small tube containing fluid into the uterus and then uses ultrasonography to examine the uterus.
• MRI. Magnetic resonance imaging provides pictures of the uterus.
• Computed tomography (CT scan). X-ray technology produces cross-sectional images of the uterus.

Managing and Treating Abnormal Uterine Bleeding

Women and their doctors can treat and manage AUB in a variety of ways. The best treatment method depends on the exact cause.

Medical treatments

Medication is often the first line of defense. Some of these drugs may also serve as contraceptives for women who wish to keep their cycles regular and avoid pregnancy. The most common types of medicines prescribed for AUB include:

• Hormonal birth controls. Helps handle irregular and severe bleeding caused by ovulation, PCOS, and fibroids. The skin patch, vaginal ring, and hormonal birth control tablets can reduce menstrual bleeding and regularize periods. Continuous use of progestin-only hormonal IUDs and injections may even eliminate periods.
• Hormone treatments. Helps address hot flashes, nocturnal sweats, vaginal dryness, and excessive menstrual flow during perimenopause, but it may increase the risk of coronary artery disease, stroke, and cancer.
• GnRH agonists. These medications, called gonadotropin-releasing hormone agonists, can halt menstruation and shrink fibroids. They’re typically prescribed for only six months or less, and then fibroids tend to grow back.
• Tranexamic acid. Prescribed for severe menstrual bleeding. It’s a pill used monthly during menstruation.
• Medications like ibuprofen can help reduce excessive bleeding and period cramps.
• Other medicines. Some bleeding disorders causing AUB may require blood-clotting medicines. Antibiotics can help treat infections leading to AUB.

Surgical treatments

Some AUB patients require surgery when medicines don’t reduce bleeding. Doctors base which surgery to use on a patient’s age, condition, and desire to have children.

Endometrial ablation

This technique destroys the uterine lining and stops bleeding. Ablation makes pregnancy unlikely, though still possible. After endometrial ablation, pregnancy might cause life-threatening bleeding, so patients need to use birth control until after menopause or undergo sterilization. This procedure also makes it harder to detect endometrial cancer.

Non-uterine fibroid treatments

Treatments that remove fibroids but don’t remove the uterus:

• Uterine artery embolization blocks the blood supply that enables fibroids to grow.
• MRI-guided ultrasound surgery uses sound waves to destroy fibroids.
• Myomectomy removes fibroids but not the uterus. Fibroids may return.

Hysterectomy

By removing the uterus, this major surgery eliminates fibroids, adenomyosis, and endometriosis when other treatments have failed. It is also used to treat endometrial cancer. Afterward, patients can no longer get pregnant and will no longer have periods.

What Happens If AUB Is Not Treated?

Hospital emergency room departments often see patients with abnormal uterine bleeding. About 5% of ED visits relate to vaginal bleeding, and 1% of patients have potentially fatal bleeding complications.

Besides the pain and difficulties from the symptoms, chronic abnormal uterine bleeding can lead to infertility, anemia and endometrial cancer. In acute cases of AUB, the complications that may result without immediate treatment include extremely heavy bleeding, anemia, low blood pressure, shock, and possibly death.

We are Here to Help

Dr. Patel provides endometrial ablation and other treatments for abnormal uterine bleeding. If you experience excessive or prolonged periods, bleeding between cycles, or other symptoms, schedule an appointment with Dr. Patel today. Our doctors use a variety of screening techniques, exams, and technology to diagnose and treat AUB patients to reduce complications and improve quality of life.

Meet Dr. Niraj Patel

A Tampa native, Dr. Niraj Patel, proudly graduated from Gaither High School and the University of South Florida. He practices personalized medicine and collaborates with his patients to provide compassionate, individualized care and develop treatment plans tailored to each patient’s unique needs. Visit his website for more information.