Abnormal uterine bleeding can occur at any age, and is one of the most common reasons women see their doctors. Abnormal uterine bleeding is considered bleeding between periods, bleeding after sex, spotting anytime in the menstrual cycle, bleeding heavier or for more days than normal, and bleeding after menopause. Menstrual cycles are typically between 21 and 35 days. Anything longer or shorter than this is considered abnormal. A lack of a period for 3-6 months, called amenorrhea, is also abnormal. There are times when it is normal for periods to be irregular. For the first few years after a girl gets her first period, usually around 9-16 years old, periods are often irregular. Also, when a woman nears menopause, the length of her cycle may change, she may bleed more or less than normal, and she may skip periods.
Some causes of abnormal bleeding include pregnancy, miscarriage, ectopic pregnancy, endometrial hyperplasia (when the lining of the uterus grows too much), and adenomyosis (when the tissue that normally grows inside the uterus, grows in the muscle wall of the uterus). Certain birth control methods like an IUD or birth control pills can also cause it. Infection of the uterus or cervix, fibroids, polyps, and polycystic ovary syndrome may also be the cause. If one has a problem with blood clotting, they may experience abnormal bleeding. Finally, certain types of cancers, like cancers of the uterus, cervix, or vagina, may lead to abnormal uterine bleeding.
Along with personal history, a number of tests may be done to diagnose the cause of your abnormal bleeding. One is a sonohysterography. For this test, fluid is placed in the uterus via a tube to take ultrasound images of the uterus. An ultrasound may also be taken of your pelvic organs. An MRI may be ordered to see your internal organs. A hysteroscopy is a test in which a thin device is inserted through the vagina and the opening of the cervix. This allows your doctor to see the inside of your uterus. Finally, and endometrial biopsy may be done. A catheter is used to take a sample of tissue from the lining of the uterus. It is then examined under a
One course of treatment may be hormonal medications. These can be prescribed as birth control pills, injections, vaginal creams, or an IUD. Another option is nonsteroidal anti-inflammatory drugs like ibuprofen or aspirin. These can help control heavy bleeding and relieve cramps. Tranexamic acid is another drug that may be used to treat heavy menstrual bleeding. Of course, if the cause of your bleeding is an infection, you will be prescribed an antibiotic.
If the cause of your bleeding is growths like polyps or fibroids, you may need surgery. This is usually done with hysteroscopy, although sometimes other methods are used. An endometrial ablation can be done to control bleeding permanently. This is when a laser, heat, or freezing is used to destroy the lining of the uterus. However, a woman may not be able to get pregnant after this procedure, and an endometrial biopsy is needed before an ablation can be considered. Finally, a hysterectomy is performed when there are no other options. This is a major surgery in which the uterus is removed. Afterwards, a woman will no longer get her period or be able to become pregnant.