Abnormal uterine bleeding can refer to bleeding between your menstrual periods, excessively prolonged or heavy menstrual bleeding. A normal menstrual period typically lasts around five days and occurs every 21 to 35 days.

How Common is Abnormal Uterine Bleeding?

Abnormal uterine bleeding, though experienced as a symptom by women, is not always reported. Therefore, it may occur in around 3% to 35% of women worldwide.

What are the Causes of Abnormal Uterine Bleeding?

The causes of abnormal uterine bleeding include:

• Structural abnormalities in the uterus (fibroids, polyps)
• Uterine cancer
• Cervical cancer
• Use of anticoagulants for blood thinning
• Platelet dysfunction
• Early pregnancy
• Hormonal changes

Polycystic ovary syndrome (PCOS) is a condition where cysts grow on the ovaries. PCOS can lead to hormonal imbalances and result in delayed or absent menstrual periods. Due to hormonal imbalances, getting pregnant might be difficult, and you may experience increased body and facial hair growth, as well as thinning of scalp hair.

Perimenopausal and menopausal women are more susceptible to hormone changes. These changes can lead to thickening of the inner lining of the uterus (endometrium), causing bleeding even when not menstruating, prolonged menstrual periods, or increased bleeding. Any bleeding in menopausal women is considered abnormal and should be investigated.

What are the Symptoms of Abnormal Uterine Bleeding?

Symptoms of abnormal uterine bleeding can vary, and some signs that your bleeding might be abnormal include:

• Menorrhagia (excessive menstrual bleeding)
• Bleeding at unusual times (between periods, after intercourse, during menopause)
• Unusually long menstrual periods (lasting seven days or more)
• Menstrual irregularities

How is Abnormal Uterine Bleeding Diagnosed?

Your doctor will ask you several questions to diagnose abnormal uterine bleeding, which may include:

• What triggers the bleeding?
• What other symptoms are you experiencing?
• Are you pregnant?

Your doctor will then conduct a physical examination, which may include:

• Pelvic exam
• Cervical exam
• Pap smear test

What Tests are Done for Abnormal Uterine Bleeding?

Tests for abnormal uterine bleeding may include:

• Pregnancy test (if not in menopause)
• Blood tests to check clotting and perform a complete blood count
• Thyroid test (thyroid problems can be related to ovarian function issues)
• Hormone levels
• Hysteroscopy (examination of the inner lining of the uterus for fibroids, polyps, or signs of cancer)
• Pelvic ultrasound
• Endometrial biopsy.

This test is recommended for:

• Women over 35 years old
• Those with a family history
• Those with risk factors for cancer

How is Abnormal Uterine Bleeding Treated?

The treatment for abnormal uterine bleeding depends on the underlying cause and may include:

• Hormonal therapy
• Birth control pills
• Progestin (can be given through an intrauterine device, implant, or injection)
• Nonsteroidal anti-inflammatory drugs

What Surgical Options are Available for Women with Abnormal Uterine Bleeding?
Various surgical options are used to treat the underlying causes of abnormal uterine bleeding. Your doctor will recommend the best option based on your condition.

If the cause of abnormal bleeding is a structural issue such as fibroids or polyps, surgery may be required.
Cancer in the endometrium or precancerous changes are usually treated with a hysterectomy, sometimes followed by radiation. Treatment for bleeding caused by cervical cancer depends on the stage of cancer. Hysterectomy is generally used to treat early stages, while more advanced stages may require radiation or chemotherapy.