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BCM - Baylor College of Medicine

Giving life to possible

Obstetrics and Gynecology

Abnormal Menstrual Bleeding

Abnormal menstrual bleeding, also called abnormal or irregular periods, is when a woman experiences bleeding that differs from her normal menstrual cycle.

In general, menstrual bleeding:

  • Occurs every 28 days
  • Lasts about 5 days
  • Involves the loss of 2 to 8 tablespoons of blood

All women are different and many variations in the timing, duration and amount of bleeding are considered normal.

However, in some cases, differences or changes in your menstrual bleeding are considered abnormal and may be a sign of another condition. Examples of abnormal menstrual bleeding include:

  • Spotting or bleeding between periods
  • Bleeding after sex
  • Unusually heavy or unusually light flow during periods
  • Periods that are longer or shorter than normal
  • Menstrual cycles that occur less or more frequently than normal
  • Bleeding after menopause
  • Missing periods

What causes abnormal menstrual bleeding?

There are many possible causes of abnormal menstrual bleeding, including:

  • Menstrual dysfunction
  • Change in hormone levels
  • Tumors, polyps or fibroids of the vagina, cervix, uterus or fallopian tubes
  • Endometrial hyperplasia (thickening/buildup of the lining of the uterus
  • Cervical disorders
  • Cancer
  • Sexually transmitted diseases
  • Vaginal injury
  • Pregnancy complications
  • Use of an intrauterine device (IUD) for birth control
  • Certain medications
  • Polycystic ovary syndrome
  • Birth control pills

How is abnormal menstrual bleeding diagnosed?

Diagnosing the cause of abnormal menstrual bleeding starts with a thorough physical exam and medical history, including detailed information on your menstrual bleeding. Keep a record of when your period begins and ends, the amount of flow, other instances of bleeding, and any other symptoms.

Depending on the suspected cause, other testing may include:

  • Blood work and urine test
  • Ultrasound
  • Endometrial biopsy – Involves taking a tiny sample of tissue from your uterus for testing.
  • Laparoscopy – Looks for abnormalities of the reproductive organs using a tiny lighted instrument inserted through a small incision in the abdomen.
  • Diagnostic hysteroscopy – An office procedure that uses a small, lighted telescope (hysteroscope) inserted through the vagina and cervix to examine inside the uterus.

How is abnormal menstrual bleeding treated?

Treatment of abnormal menstrual bleeding will depend on the cause, patient's age and other factors. Treatments can range from lifestyle changes to medical options to surgery.

Treatment options include:

Medical treatment. Using birth control pills or hormones to control bleeding

Surgical treatment. To remove growths such as polyps or fibroids that can cause abnormal bleeding. Surgery can often be performed using hysteroscopy, a minimally invasive approach to examine and treat the inside of the uterus.

Additional options when other forms of treatment have failed or aren't viable include endometrial ablation (to destroy the lining of the uterus) and hysterectomy (surgery to remove the uterus).