Abnormal Uterine Bleeding

Bleeding between periods
Bleeding after sex
Spotting anytime in the menstrual cycle
Bleeding heavier or for more days than normal
Bleeding after menopause
Menstrual cycles that are longer than 35 days or shorter than 21 days are abnormal.
The lack of periods for 3-6 months (amenorrhea) also is abnormal.

The menstrual cycle begins with the first day of bleeding of one period and ends with the first day of the next.
In most women, this cycle lasts about 28 days.
Cycles that are shorter or longer by up to 7 days are normal.

Abnormal bleeding can occur at any age.
However, at certain times in a woman’s life it is common for periods to be somewhat irregular.
Age 9-16 years
- They may not occur on schedule in the first few years after a girl has her first period (around age 9-16 years).
Age 35 years.
- The cycle may get shorter near age 35 years.
Around age 50 years
- It often gets shorter as a woman nears menopause (around age 50 years).
- It also is normal then to skip periods or for bleeding to get lighter or heavier.

Common Causes
- Hormonal Imbalance
  - Too much or not enough of the hormones that regulate the menstrual cycle can cause abnormal or heavy bleeding.
  - This imbalance can be caused by many things, including thyroid problems or some medications.
- Pregnancy
- Miscarriage
- Ectopic pregnancy
- Problems linked to some birth control methods,
  - Intrauterine device (IUD)
  - Birth control pills
- Infection of the uterus or cervix
- Fibroids
- Problems with blood clotting
- Polyps
- Certain types of cancer, such as cancer of the uterus, cervix, or vagina
- Chronic medical conditions (for instance, thyroid problems and diabetes)
Diagnosis
- Your health care provider may start by checking for problems most common in your age group.
- Some of them are not serious and are easy to treat.

Personal and family health history as well as your menstrual cycle.
Menstrual Cycle Details
- Keep track of your menstrual cycle before your visit.
- Note the dates, length, and type (light, medium, heavy, or spotting) of your bleeding on a calendar.
Physical exam.
Blood tests.
- Blood count
- Hormone levels
- Rule out some diseases of the blood.
A test to see if you are pregnant.

Where can these tests be done?
- Some of these tests can be done in your health care provider’s office.
- Others may be done at a hospital or surgical center:
Tests
- Ultrasound
  - Sound waves are used to make a picture of the pelvic organs.
- Endometrial biopsy
  - Using a small or thin catheter (tube)
  - Tissue is taken from the lining of the uterus (endometrium).
  - It is looked at under a microscope.
- Sonohysterography
  - Fluid is placed in the uterus through a thin tube
  - While ultrasound images are made of the uterus.
- Hysteroscopy
  - A thin device is inserted through the vagina and the opening of the cervix.
  - It lets the health care provider view the inside of the uterus.
- Hysterosalpingography
  - Dye is injected into the uterus and fallopian tubes.
  - Then an X-ray is taken.
- Dilation and curettage (D&C) — The opening of the cervix is enlarged.
  - Tissue is gently scraped or suctioned from the lining of the uterus.
  - It is examined under a microscope.
- Laparoscopy
  - A thin device like a telescope is inserted through a small cut
  - Just below or through the navel to view the inside of the abdomen.

Treatment falls into three types
- Medications, such as hormones
- Surgery
- “watch and wait” before trying the other two treatments.
The type of treatment will depend on many factors, including
- The cause of the bleeding.
- Your age
- Whether you want to have children also play a role.
Most women can be treated with medications.

Some women may need to have surgery to remove growths
- Such as polyps or fibroids that cause bleeding.
Surgical options
- Some fibroids can be removed with hysteroscopy.
- Endometrial ablation may be used to control bleeding (see the FAQ Endometrial Ablation).
  - It is intended to stop or reduce bleeding permanently.
  - An endometrial biopsy is needed before ablation is considered.
- Hysterectomy may be done when other forms of treatment have failed or they are not an option.
  - Hysterectomy is major surgery.
  - Afterward, a woman no longer has periods.
  - She also cannot get pregnant.

Cherokee Women's Health