What is abnormal uterine bleeding?

Abnormal uterine bleeding is irregular bleeding from the uterus. It may be bleeding that is heavier, lighter, or lasts longer than your usual period. Or it may be bleeding that doesn't occur at your regular time. For example, you may have heavy bleeding during your period or in between periods. Let your doctor know if your bleeding is different than usual. They can check for problems.

Bleeding during pregnancy is a different problem. If you are pregnant and have any amount of bleeding from the vagina, be sure to tell your doctor.

Symptoms of abnormal uterine bleeding include:

• Getting your period more or less often than normal. A normal adult menstrual cycle is about 21 to 35 days long. A normal teen cycle is about 21 to 45 days.
• Periods that last longer than 7 days.
• Bleeding during your period that is lighter or heavier than usual. With heavy bleeding, you may soak through your pads or tampons often.
• Bleeding when you don't expect to, such as between periods or after sex.

Your doctor will review your history of symptoms and menstrual periods. Your doctor will ask how often, how long, and how much you have been bleeding. (If you can, bring with you a record of the days you were bleeding, how heavy or light the flow was, and how you felt each day.)

You may also have tests to help find the cause of your symptoms and to rule out serious health problems. These tests may include:

• A pelvic exam.
• A fluid sample from your cervix or vagina.
• A Pap or HPV test.
• A urine test.
• A blood test.
• An ultrasound.
• A biopsy. For this test, your doctor takes a tiny sample of tissue from your uterus.

Abnormal uterine bleeding usually can be treated with medicine, hormone therapy, or both. Surgery may be done for bleeding that can't be controlled with medicine or hormones.

Acute, severe uterine bleeding

Severe uterine bleeding is often treated as an emergency. It may be treated with medicine, such as high-dose estrogen. Or it may be treated with a procedure, such as a dilation and curettage (D&C). When needed, a blood transfusion may be used to quickly restore blood volume.

Later, you and your doctor can choose a treatment that is safe for the longer term.

Ongoing uterine bleeding

Your treatment choices depend on your age, the cause of your bleeding, and if you plan to get pregnant in the future. Treatments include:

Hormone therapy

• Birth control pills, patch, or ring. These can help control your cycle and reduce menstrual bleeding and cramping.
• Hormonal IUD. This is a birth control device that your doctor places inside your uterus. It releases progestin and can reduce bleeding and cramping.
• Progestin-only birth control, such as mini-pills, implants, or shots. These types of birth control can reduce bleeding and cramping.
• Progestin pills. These are progestin-only pills that can help reduce bleeding but don't prevent pregnancy.

Non-hormonal medicines

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin). Taking an NSAID can reduce bleeding and pain during your period.
• Tranexamic acid (such as Lysteda). This is a medicine that reduces bleeding by helping your blood to clot.

Surgery

• Hysteroscopy. This procedure is done to diagnose abnormal uterine bleeding. But it can also treat some problems at the same time. For example, fibroids or polyps may be removed during this procedure.
• Endometrial ablation. This procedure destroys the endometrium. This reduces or stops uterine bleeding. But it isn't an option if you would like to get pregnant in the future.
• Hysterectomy, a surgery to remove the uterus. This may be an option if heavy bleeding can't be controlled or when the cause of bleeding can't be found and treated. You won't be able to get pregnant after a hysterectomy.

Sometimes symptoms get better without treatment. After a doctor rules out serious problems, some people choose to wait and see if symptoms get better on their own.

You can use home treatment for some problems related to abnormal uterine bleeding.

A nonsteroidal anti-inflammatory drug (NSAID), such as over-the-counter ibuprofen (Advil, Motrin), can help reduce bleeding and menstrual pain. It works best when you start taking it 1 to 2 days before you expect bleeding or pain to start. If you don't know when your period will start next, take your first dose of an NSAID as soon as bleeding or premenstrual pain starts. Be safe with medicines, and follow your doctor's instructions.

Irregular menstrual bleeding can lead to low levels of iron in the blood. This condition is known as iron deficiency anemia. You can help prevent anemia by increasing the amount of iron in your diet.