Abnormal Bleeding

What counts as abnormal bleeding?

A normal menstrual cycle runs every 21-35 days, with bleeding lasting up to 7 days. Abnormal bleeding includes:

• Bleeding between periods (spotting or heavier flow)
• Heavy periods requiring changing a pad or tampon every hour or two, or passing large clots
• Periods lasting longer than 7 days
• Absent periods for more than 3 months (when not pregnant or menopausal)
• Fewer than 9 periods per year or highly irregular cycles
• Any bleeding after menopause -- this always requires evaluation

Common causes

Hormonal imbalances

The most common cause in women of reproductive age. Conditions like PCOS disrupt the normal hormonal cycle that controls the uterine lining.

Uterine fibroids

Noncancerous growths in the uterine wall that can cause heavy, prolonged periods and pelvic pressure.

Endometrial polyps

Small, usually benign growths on the lining of the uterus that can cause irregular or heavy bleeding.

Endometriosis and adenomyosis

Both conditions involve uterine lining tissue in abnormal locations, causing heavy, painful periods.

Thyroid disorders

Both overactive and underactive thyroid conditions can affect the menstrual cycle.

Evaluation

The team performs a thorough evaluation including a pelvic exam, blood work (thyroid panel and hormone levels), Pap smear, and pelvic ultrasound. An endometrial biopsy may be recommended in certain cases.

Treatment

Medications

Hormonal birth control is often the first-line treatment. Tranexamic acid can reduce heavy bleeding during periods.

Surgical options

• Endometrial ablation -- Destroys the uterine lining to significantly reduce or stop heavy bleeding. Not appropriate if you are planning future pregnancies.
• Fibroid removal (myomectomy) -- Removes fibroids while preserving the uterus.
• Polyp removal -- A simple hysteroscopic procedure to remove polyps from the uterine lining.