Obstetrics and Gynecology

Abnormal Uterine Bleeding

Abnormal uterine bleeding is bleeding that is different from a woman's normal menstrual cycle, unrelated to menstruation, or unusual for her age. It is one of the most common health issues for women.

Examples of abnormal uterine bleeding include:

  • Bleeding between periods
  • Bleeding after sex
  • Spotting anytime in the menstrual cycle
  • Bleeding heavier or for more days than normal
  • Bleeding after menopause

What causes abnormal uterine bleeding?

Abnormal uterine bleeding can have many causes and can occur at any age. It may be a sign of a gynecologic condition or other medical problem. Possible causes include:

  • Pregnancy or ectopic pregnancy
  • Miscarriage
  • Hormonal imbalance
  • Problems linked to birth control methods
  • Infection of the uterus or cervix
  • Fibroids or polyps
  • Problems with blood clotting
  • Cancer of the uterus, cervix, or vagina
  • Chronic medical conditions such as thyroid problems and diabetes
  • Endometrial hyperplasia

How is abnormal uterine bleeding diagnosed?

Diagnosing the cause of abnormal uterine bleeding starts with a complete medical history, including detailed information on your normal menstrual cycle and the abnormal bleeding you are experiencing. Keep a record of the dates, duration, and amount of abnormal bleeding.

A physical exam, pelvic exam, and Pap smear should also be conducted.

Additional tests may include:

  • Screening for STDs (sexually transmitted diseases)
  • Blood tests
  • Ultrasound. To take images of your pelvic organs.
  • Endometrial biopsy. To obtain and analyze a tissue sample from the lining of your uterus.
  • Sonohysterography. An ultrasound using sterile saline to expand the uterine cavity for easier imaging.
  • Hysteroscopy. An office procedure using a small, lighted telescope (hysteroscope) inserted through the vagina and cervix to see the inside of the uterus.
  • Hysterosalpingography. An x-ray taken after injecting dye into the uterus and fallopian tubes.
  • Dilation and curettage (D&C). To obtain tissue from the lining of the uterus for examination under a microscope.
  • Laparoscopy. A thin, lighted tube with a camera on the end (laparoscope) is inserted into the abdomen through a small incision, allowing the surgeon to see inside the abdomen.

How is abnormal uterine bleeding treated?

Treatment of abnormal uterine bleeding depends on the cause, patient's age and other factors. Treatment options include:

  • Wait and watch approach
  • Medical treatment. Using hormones such as oral contraceptives, estrogen and progestins, and other medications.
  • Surgical treatment. To remove growths such as polyps or fibroids that can cause bleeding. Surgery can often be performed using hysteroscopy, a minimally invasive approach to examine and treat areas of concern inside 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).