Abnormal Menstrual Bleeding

Many women, of all ages, have abnormal bleeding during their lives. Doctors define abnormal bleeding as:

• Bleeding or spotting between periods
• Bleeding or spotting after sex
• Heavy bleeding during your period
• Menstrual cycles that are longer than 38 days or shorter than 24 days
• “Irregular” periods in which cycle length varies by more than 7–9 days
• Bleeding after menopause

The normal length of the menstrual cycle is typically between 21 days and 35 days. A normal menstrual period generally lasts up to 7 days.

Abnormal bleeding can occur at any age. However, at certain times in a woman’s life it is common for periods to be somewhat irregular. Periods may not occur regularly when a girl first starts having her period (around age 9–14 years). During perimenopause (beginning in the mid–40s), the number of days between periods may change. It also is normal to skip periods or for bleeding to get lighter or heavier during perimenopause.

A variety of things can cause abnormal bleeding :

• Problems with ovulation
• Lab abnormalities (ie thyroid, prolactin)
• Fibroids or polyps
• Endometriosis or adenomyosis
• Bleeding disorders
• Side effects from birth control methods
• Polycystic ovarian syndome
• Miscarriage
• Ectopic pregnancy
• Certain types of cancer, such as cancer of the uterus

Your obstetrician–gynecologist (ob-gyn) or other health care professional may start by checking for problems most common in your age group. Some of them are not serious and are easy to treat. Others can be more serious. Your should check them all.

Your ob-gyn or other health care professional will ask about your health history and your menstrual cycle. It may be helpful to keep track of your menstrual cycle before your visit. Note the dates, length, and type (light, medium, heavy, or spotting) of your bleeding on a calendar. No, you can use a smartphone app designed to track menstrual cycles.

You’ll have a physical exam, and you also may have blood tests. These tests check your blood count and hormone levels and rule out some diseases of the blood. You also may have a pregnancy test and tests for sexually transmitted infections (STIs).

Based on your symptoms and your age, other tests may be needed. Your doctor can do some of these tests in the office. They may do others at a hospital or surgical center:

Ultrasound exam — This test uses sound waves to make a picture of the pelvic organs.

Hysteroscopy — In this exam, your doctor inserts a thin, lighted scope  through the vagina and the opening of the cervix. It allows your ob-gyn or other health care professional to see the inside of the uterus.

Endometrial biopsy — A sample of the endometrium is removed and looked at under a microscope.

Sonohysterography — Fluid is placed in the uterus through a thin tube while ultrasound images are made of the inside of the uterus.

Magnetic resonance imaging (MRI)—An MRI exam uses a strong magnetic field and sound waves to create images of the internal organs.

Computed tomography (CT) — This X-ray procedure shows internal organs and structures in cross section.

Your doctor may first use medicine to treat irregular or heavy menstrual bleeding. The medications that may be used include the following:

• Hormonal birth control methods – Hormones can lighten the menstrual flow and help periods become regular
• Gonadotropin-releasing hormone (GnRH) agonists — These drugs can stop the menstrual cycle and reduce the size of fibroids.
• Tranexamic acid — This medication treats heavy menstrual bleeding.
• Nonsteroidal anti-inflammatory drugs — These drugs, which include ibuprofen, may help control heavy bleeding and relieve menstrual cramps.
• Antibiotics — If you have an infection, you may be given an antibiotic.
• Special medications — If you have a bleeding disorder, your treatment may include medication to help your blood clot.

• If medication does not reduce your bleeding, a surgical procedure may be needed. There are different types of surgery depending on your condition, your age, and whether you want to have more children.
• Endometrial ablation destroys the lining of the uterus. It stops or reduces the total amount of bleeding. Pregnancy is not recommended after ablation, but it can happen. If it does, the risk of serious complications, including life-threatening bleeding, increases greatly. If you have this procedure, you will need to use birth control until after menopause.
• Uterine fibroid embolization treats fibroids. This procedure blocks the blood vessels to the uterus, which in turn stops the blood flow that fibroids need to grow. Another treatment, myomectomy, removes the fibroids but not the uterus.
• Hysterectomy, the surgical removal of the uterus, is used to treat some conditions or when other treatments have failed. Hysterectomy also is used to treat endometrial cancer. After the uterus is removed, a woman can no longer get pregnant and will no longer have periods.