What You Should Know About Abnormal Uterine Bleeding

When Is Your Period Cause for Concern?

Pile of tampons
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Most women experience abnormal uterine bleeding at least once during their reproductive years. The most common times for women to experience heavy menstrual periods are during the first few years of menstruation, and then again during the final two to three years before menopause.

How Do I Know When My Menstrual Bleeding is Abnormal?

You may be experiencing abnormal uterine bleeding if you're forced to change your pads or tampons more than every one or two hours.

There may also be cause for concern if your period lasts more than seven days.

On the flip side, abnormal uterine bleeding is also used to describe amenorrhea or the absence of menstruation.

Uterine bleeding is also always abnormal when:

Some women are concerned, needlessly, by clots in their menstruation. In most instances, brown, black, or red menstrual blood clots are normal. These blood clots are part of the endometrium, which is the lining of the uterus. This is what is typically shed during menstruation.

What Causes Abnormal Uterine Bleeding?

Heavy menstruation, also known as menorrhagia, is usually the result of a hormonal imbalance. Another common cause of abnormal uterine bleeding is fibroid tumors. Other causes of excessive bleeding that your healthcare provider should consider include:

Women using intrauterine devices (IUDs) may also experience excessive or prolonged periods. If you experience excessive uterine bleeding while using an IUD, the IUD should be removed and replaced with an alternative birth control method.

Usually detected soon after menstruation begins, platelet disorders are the most common blood disorder that causes excessive bleeding; the most common platelet disorder is von Willebrand's disease. Women with von Willebrand's disease commonly will experience not only heavy menstrual bleeding, but also nosebleeds, easy bruising, and blood in the stool.

pelvic exam is the first step you should take in determining the cause of your abnormal uterine bleeding. This exam should include a Pap smear, in addition to lab tests and, if appropriate, a pregnancy test. An ultrasound is often performed to check for any abnormalities, such as fibroids. And an endometrial biopsy, D&C, or hysteroscopy may also be performed to further evaluate the condition of your uterus.

How To Treat Your Abnormal Uterine Bleeding

Relief from abnormal uterine bleeding or menorrhagia is usually found by treating either the medical or physical cause. Abnormal bleeding that does not appear to be related to another underlying disease or condition is often successfully treated with progesterone or a combination of progesterone and estrogen, many times given in the form of an oral contraceptive.

Women who experience menorrhagia, or excessive uterine bleeding, on a regular basis should be monitored closely for anemia, and treatment with iron supplementation may be necessary.

Often, severe bleeding can also be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. These drugs can help reduce bleeding, in addition to easing the pain of menstrual cramps.

Endometrial ablation, once commonly used to treat excessive bleeding in women past child-bearing age who wanted to avoid hysterectomy, has now been replaced by a therapy called thermal balloon ablation. In most cases, thermal balloon ablation ends bleeding by destroying the lining of the uterus. Only women who do not want to have children are treated in this manner, as this treatment usually results in infertility.

However, this procedure does not guarantee that pregnancy won't happen. Women who do not desire children should continue using their preferred birth control method.

Unless you're pregnant when you experience abnormal uterine bleeding, a single episode of heavy menstrual bleeding usually does not require treatment. The exception to this, however, is when excessive uterine bleeding continues for over 24 hours.

Contact your gynecologist whenever you're unsure about any reproductive health symptom you experience.


ACOG Patient Education. Abnormal Uterine Bleeding.

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