The term “abnormal uterine bleeding” has a broad definition, encompassing a number of bleeding abnormalities that can occur during someone’s period. It includes excessive blood loss, a period that occurs irregularly or one that happens too often or rarely. Many factors contribute to abnormal uterine bleeding. (Spoiler – even though age is a factor, it’s not the only cause!) We’re covering all of the bases. Causes, diagnosis and treatment, and what it means for those who are trying to conceive.
Understanding Abnormal Uterine Bleeding
Abnormal uterine bleeding is generally defined as bleeding that occurs outside the “normal” parameters of menstruation. As we discuss “normal,” remember that everybody is unique and, even if your cycle falls outside of these measurements, your cycle may still be considered healthy and normal.
The average cycle lasts between 21 and 38 days (though a regular cycle may be up to 45 days). A cycle is measured from the first day of your period through the day before your next period. The average period (or menstrual bleeding) typically lasts between 3 and 7 days. While it’s nearly impossible to measure exactly, the average amount of blood loss per period is about 6 teaspoons (though normal can range up to 16 teaspoons).
Anything out of the “normal” range may be considered abnormal uterine bleeding, but there are some patterns that may fall within the definition of “normal” for some and “abnormal” for others. For example, if you experience heavier-than-normal blood loss, develop irregular cycles, bleed for longer periods of time or have worsening cramps, you may have developed abnormal terrine bleeding. There are a variety of conditions that cause abnormal uterine bleeding, and many can arise in the later years of menses. All cases of abnormal uterine bleeding should be discussed with a medical provider.
Causes of Abnormal Uterine Bleeding
The causes of abnormal uterine bleeding can be classified as structural (due to a body part) or non-structural (generally due to cellular signaling). Structural causes often involve abnormalities in the uterus, such as:
- Polyps: Growths in the uterine lining that can cause irregular bleeding.
- Fibroids: Benign tumors in the uterine wall that can lead to heavy bleeding.
- Adenomyosis: A condition where the uterine lining grows into the muscle layer, causing pain and heavy periods.
- Malignancy or Hyperplasia: Cancerous or precancerous changes in the uterine lining.
Non-structural causes include hormonal imbalance, ovulation dysfunction, and systemic conditions such as bleeding disorders or thyroid disorders. Certain medications that may cause abnormal uterine bleeding are blood thinners or hormone-derived medications.
Abnormal Uterine Bleeding in Adolescents
In adults, various hormones are sent between the brain and female reproductive system (the ovaries, uterus and vagina), directing the menstrual cycle to proceed through a continuous feedback loop. In adolescents, these signals are just beginning to develop, resulting in abnormal uterine bleeding for many young menstruators.
Adolescence is usually a time when abnormal uterine bleeding is actually considered normal. Most bleeding patterns during this time are abnormal, and they usually self-correct after two or three years. However, abnormal patterns beyond adolescence may be due to larger health issues, including:
- Bleeding disorders (like von Willebrand disease)
- Endocrine abnormalities (like PCOS – polycystic ovarian syndrome)
- Stress, extreme weight fluctuations or excessive exercise
How to Abnormal Uterine Bleeding is Diagnosed
There are a few different pieces of information that are considered when discussing menstrual bleeding patterns, including medical history, family history and physical exam. For younger people, the biggest factors contributing to abnormal uterine bleeding are bleeding disorders (often noted in other family members as well), lifestyle (weight changes or exercise patterns) and incorrect or insufficient documentation. In older individuals, hormonal causes and pregnancy are first evaluated. If there is still no answer as to why someone is experiencing abnormal uterine bleeding, they may be referred for ultrasound imaging or endometrial biopsy depending on the suspected condition.
Abnormal Uterine Bleeding Treatment
Treatment is based on the underlying cause, how severe the abnormalities are, the patient's age and their reproductive goals (like if they want pregnancy to be an option in the future). The most common treatments include:
- Medications. These include hormonal treatments like birth control pills and intrauterine devices (IUDs). They work by regulating cycles and reducing bleeding. Non-hormonal treatments include tranexamic acid and NSAIDs (like ibuprofen) which can help by reducing blood loss and alleviating pain.
- Iron Supplements: These are very important for patients who experience heavy bleeding. Heavy bleeding causing anemia. Because iron is an important part of healthy red blood cells, iron supplements can treat anemia and reduce fatigue.
- Lifestyle Changes: Weight changes or weight extremes (like weighing too little or weighing too much) can disrupt the signaling that directs the menstrual cycle. Similarly, exercising too much uses up a lot of energy, and when the body does not have enough energy it can pause the menstrual cycle. Maintaining a steady weight, reducing stress and getting a moderate amount of exercise may improve abnormal bleeding patterns.
- Surgical Options: In extreme cases, endometrial ablation (,which involves removing the lining of the uterus) or hysterectomy (total removal of the uterus) might be considered in patients whose bleeding does not improve with other treatments.
Conclusion
Abnormal uterine bleeding is a complicated condition, with multiple causes and treatments related to age and specific body conditions. Whereas most cases (especially those in adolescence) resolve with time, persistent or severe abnormal uterine bleeding needs medical intervention. Early detection and proper management reduces complications, enhances quality of life and supports reproductive health. A comprehensive discussion and evaluation with a medical provider can help determine if medication, lifestyle modifications and/or surgery is the most appropriate management.