Abnormal bleeding, sometimes referred to as abnormal uterine bleeding (AUB) or abnormal vaginal bleeding, refers to any bleeding that happens outside a woman’s menstrual cycle. It can have many causes, ranging from hormonal imbalances to more concerning conditions like cancer.
While irregular uterine bleeding isn’t always serious, it can be a sign of an underlying health condition. If you notice any unusual bleeding, get in touch right away!
What is abnormal uterine bleeding?
On average, a normal menstrual cycle occurs every 28 days, and the period of bleeding lasts three to seven days. Bleeding that occurs outside of this pattern is known as abnormal bleeding and sometimes indicates a problem with the cervix, uterus, or other gynecological problems.
What are abnormal uterine bleeding symptoms?
Abnormal menstrual bleeding patterns can take many forms, including spotting in between periods or unusually heavy menstrual bleeding. Abnormal vaginal bleeding symptoms can be described as:
- Spotting or bleeding between periods
- Heavier menstrual flow
- Bleeding for a longer period of time than normal (menorrhagia)
- Bleeding after sex
- Bleeding after menopause
- Lack of menstrual bleeding for three to six months (amenorrhea)
These symptoms may be more common at some stages of life than others. For example, one potential cause of irregular vaginal bleeding is the failure of regular ovulation, known as anovulation. Anovulatory cycles are more likely to occur in teenagers and in women who are approaching menopause.
What are potential causes of abnormal uterine bleeding?
There are many possible causes of irregular bleeding outside of menstruation, some of them more worrisome than others.
Hormonal imbalances
In most women, abnormal uterine bleeding is caused by an imbalance of the hormones estrogen and progesterone. When hormone levels are the problem, healthcare providers call the problem dysfunctional uterine bleeding (DUB). Abnormal bleeding caused by hormone imbalance is more common in teenagers and perimenopausal women.
As women approach the age of menopause (perimenopause), their cycles may get longer, or they may skip a period once in a while. With postmenopausal women, AUB includes vaginal bleeding 12 months or more after your menstrual cycles have stopped or unpredictable bleeding in postmenopausal women who have been receiving hormone therapy for 12 months or more.
Alternatively, adolescents ages 9-15 might experience some abnormal bleeding while their menstrual cycles are just getting started as they try to adjust to their fluctuating levels of hormones. Generally, these types of abnormal uterine bleeding are considered normal.
Other causes of abnormal bleeding
Some other common causes of abnormal uterine and vaginal bleeding include:
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- Infections (cervical or uterine)
- Contraceptives (intrauterine device(IUD) or birth control pills)
- Blood clotting problems
- Bleeding disorders
- Uterine fibroids (leiomyomas)
- Polyps
- Sexually transmitted infections (STIs)
- Pregnancy
- Ectopic pregnancy
- Miscarriage
- Adenomyosis (a disorder of the endometrial tissue)
- Endometrial hyperplasia
- Polycystic ovary syndrome(PCOS)
- Cervical, uterine, vaginal, or endometrial cancer
- Thyroid dysfunction (hypothyroidism, hyperthyroidism, and thyroid disease)
How does Dr. Aliabadi diagnose the cause of abnormal bleeding?
If you’re concerned about abnormal bleeding, please make an appointment with us. Dr. Aliabadi will being by reviewing your medical history and performing a physical examination. If you can, keep a log of the dates that you begin and stop bleeding, record whether the bleeding was light, medium, or heavy, and any other symptoms you may have.
Due to the wide range of potential causes, we usually want to perform a pelvic exam and ultrasound at your appointment. We may also order a blood test to check that your blood count isn’t too low due to blood loss, which could cause anemia. Additionally, a pregnancy test may be recommended to rule out an ectopic pregnancy or miscarriage.
Some other tests can help with diagnosis as well. Depending on the results of your exam and blood test, we may want to get a better idea of what’s going on in your uterus by using:
- MRI — Advanced imaging allows us to visually examine your pelvic organs for abnormalities.
- Sonohysterography — A procedure in which an ultrasound is performed after the uterus is filled with fluid.
- Hysteroscopy— Inserting a long, thin device with a light and camera through the cervix allows us to view the inside of the uterine cavity. In some cases, this may be performed with dilation and curettage, in which endometrium tissue is scaped or suctioned away.
- Endometrial biopsy — A sample of endometrial tissue is taken from the uterine lining and examined under a microscope to check for abnormal cells.
These tests can indicate the presence of endometrial polyps, growths, tumors, or abnormalities with the lining of the uterus. They can also help rule out other medical conditions that could be causing spotting, heavy periods, or irregular bleeding.
Treatment options for abnormal bleeding
Your particular course of treatment will depend upon your diagnosis, age, and family planning wishes.
According to the American College of Obstetricians and Gynecologists (ACOG), oral contraceptives (either estrogen-progesterone or progestin-only birth control pills) or other hormone therapy, such as gonadotropin-releasing hormone are prescribed as the first line of treatment for women who have abnormal or heavy periods.
These hormones can lighten menstrual flow. They also help make your menstrual periods more regular. Dr. Aliabadi will discuss your options and possible side effects with you. Some women have to try a few different types of hormonal treatment before they find the one that works for them.
Other drugs used to treat abnormal bleeding include antibiotics (for infections) and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, which can control heavy bleeding and ease cramping.
If medication does not reduce your abnormal bleeding, a surgical procedure may be needed. Uterine polyps or fibroids are often removed surgically. Under certain circumstances, endometrial ablation or complete hysterectomy may be recommended. Endometrial ablation is a surgical procedure that destroys the lining of the uterus but does not remove the uterus. Endometrial ablation may stop all menstrual bleeding in some cases. These surgeries will permanently reduce bleeding or stop the bleeding entirely and should only be performed when a woman is sure that she no longer wants to get pregnant.
Have questions about abnormal bleeding? Talk to Dr. Aliabadi
Dr. Aliabadi and her compassionate gynecology and obstetrics team are experts in women’s health care. When you’re treated by Dr. Aliabadi, you’re guaranteed to feel safe, heard, and well cared for.
We invite you to establish care with Dr. Aliabadi. Please make an appointment online or call us at (844) 863-6700.
The practice of Dr. Thais Aliabadi and the Outpatient Hysterectomy Center is conveniently located for patients throughout Southern California and the Los Angeles area. We are near Beverly Hills, West Hollywood, Santa Monica, West Los Angeles, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.
Abnormal bleeding FAQs
Can HPV cause abnormal bleeding?
HPV, or human papillomavirus, is a sexually transmitted infection that is a primary cause of cervical cancer. While HPV doesn’t usually cause noticeable symptoms, bleeding after sex or bleeding and spotting in between periods that occur after an HPV infection can indicate cervical cancer.
Can stress cause abnormal bleeding?
Because stress can affect your hormone levels, it can cause abnormal bleeding.
What can cause lower back pain and abnormal bleeding?
Lower back pain coupled with abnormal bleeding can have several causes, including endometriosis, ovarian cysts, pelvic inflammatory disease, fibroids, or pregnancy-related conditions. If you’re experiencing any abnormal bleeding, contact our office right away.
Resources
Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women | ACOG https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/04/management-of-acute-abnormal-uterine-bleeding-in-nonpregnant-reproductive-aged-women
Angiogenesis in abnormal uterine bleeding: a narrative review – PubMed https://pubmed.ncbi.nlm.nih.gov/36857162
Supported by her warm professional team, Dr. Aliabadi treats women through all phases of life and cherishes the special one-on-one relationship between patient and doctor.