Are you tired of bleeding? Abnormal uterine bleeding is definitely one of the most common conditions we encounter at Dedicated Women’s Health Specialists. As leading gynecologists, we are always ready to help you determine the cause of bleeding and ensure that you receive the most effective treatment available as quickly as possible. We are located in Puyallup/Tacoma area and serve women in the greater South Sound region.

Call – (253) 840-4444

Abnormal Uterine Bleeding Q & A

What is Considered Abnormal Uterine Bleeding for Women?
Abnormal uterine bleeding can encompass a wide range of problems that can occur throughout the reproductive years and beyond. Vaginal bleeding is considered to be abnormal in the following circumstances:

  • Bleeding before puberty in young children.
  • Menstrual periods are too long. Normal periods occur about every 4 weeks and lasts 3-5 days on average. If you bleed 7 or more days, there may be a problem.
  • Menstrual periods are too heavy. Women typically lose about 30 ml of blood during a normal period. Most women will change tampons or pads 2-3 times a day during the heavy part of the menstrual cycle. If you are changing more often or pass blood clots, this means your periods are too heavy.
  • Bleeding between menstrual periods. The amount of bleeding may vary from spotting to heavy. Either way, this is not normal and should be investigated.
  • Cyclic interval (number of days from the first day of one period to the first day of next period) is normally about 4 weeks. There is a problem if your periods are occurring more frequently than every 3 weeks or less frequently than 5 weeks,
  • Irregular periods. Some women have periods that have no regularity and they seem to occur at totally random intervals. If your periods are occurring in unpredictable manner, there is a problem and you should undergo evaluation.
  • No periods for 3 months or longer. This is called amenorrhea. Unless there is a known reason why you are not having periods, it requires evaluation.
  • Bleeding after menopause. Any bleeding that occurs after menopause is not normal and must be investigated. In most instances, cancer must be ruled out.
  • Bleeding associated with pregnancy. Any bleeding during pregnancy is not normal and must be evaluated promptly. Sometimes, women do not even know they are pregnant and think they are having an abnormal period.

What Causes Abnormal Uterine Bleeding?
There are numerous causes of abnormal bleeding. Some of the most common causes include:

  • Medications- some medications are associated with bleeding
  • Hormonal agents such as birth control pills, contraceptive implants, and injections
  • An IUD or intrauterine device
  • Infection of the cervix, vagina, uterus, fallopian tubes or ovaries.
  • Pelvic Inflammatory Disease
  • Uterine fibroids
  • Endometriosis (particularly involving the uterine wall)
  • Ovulation
  • PCOS, or polycystic ovary syndrome
  • Cancer of the uterus or ovary
  • Thyroid dysfunction
  • Endometrial polyp- mass in the uterine cavity
  • Hormonal imbalance
  • Bleeding disorder (such as von Willebrand disease)
  • In some instances, extreme emotional stress and too much physical activity can cause atypical bleeding.

How is Abnormal Uterine Bleeding Evaluated?
First, a detailed history of abnormal bleeding will be taken followed by physical examination. Often, some laboratory studies will be needed which may include blood count, thyroid and pituitary function tests, hormone levels, coagulation profile, etc. Regular and/or specialized ultrasound examination may need to be performed. Occasionally, tissue biopsy (endometrial biopsy) will be recommended. Once the reason for bleeding has been identified, the physician will be able to address the issue and ensure that it is successfully managed.

What Are the Treatment Options for Abnormal Uterine Bleeding?
Once the cause for abnormal bleeding has been identified, we can proceed with a definitive treatment plan which includes:

  • Hormone therapy- This could be in the form of pills, injections, or IUD.
  • Surgery- D&C, hysteroscopy and removal of polyps or fibroids, and hysterectomy.
  • Endometrial ablation- This is a minimally invasive alternative to hysterectomy to eliminate or minimize abnormal bleeding by cauterizing the lining of the uterus. Today, many women undergo endometrial ablation who would have been treated with hysterectomy in the past. There are various techniques used to achieve the desired outcome. Typically, endometrial ablation is performed hysteroscopically (no incision) in the operating room under anesthesia.