Abnormal Uterine Bleeding

Abnormal Uterine Bleeding

What is abnormal uterine bleeding?

A regular menstrual cycle generally lasts 24 to 38 days with bleeding that can last up to 8 days. Bleeding that lasts for two weeks or longer, bleeding that starts and stops throughout the month or missing your period entirely may be signs that you should consult with a physician. 

What are signs of abnormal uterine bleeding?

Abnormal uterine bleeding may include:

  • Bleeding or spotting between periods
  • Bleeding or spotting during or after sex
  • Bleeding or spotting after menopause
  • Bleeding that lasts longer than eight days
  • Menstrual cycles lasting longer than 38 days or shorter than 24 days
  • Heavy bleeding during your period

What causes abnormal uterine bleeding?

The regularity of your menstrual cycle can be affected by many different factors, such as hormone imbalance, pregnancy, and abnormal growths of the uterus.

Some of the causes of abnormal uterine bleeding include:

Problems with ovulation

This usually occurs during the first few years after your periods start (9-14 years of age) and during perimenopause (starting as early as mid-40s). This can also occur if you have a hormone imbalance, such as thyroid disease or polycystic ovary syndrome.

Pregnancy

This can include a miscarriage or an ectopic pregnancy. 

Uterine fibroids

A fibroid is a benign (non-cancerous) tumor in the myometrium (wall of the uterus). The primary symptoms of uterine fibroids are heavy menstrual bleeding, prolonged periods, cramping and pain. Uterine fibroids are typically diagnosed with an ultrasound. Learn more. 

Endometriosis

This is an abnormal growth of tissue in the endometrium (lining of the uterus). The most common symptoms of endometriosis are pain, heavy menstrual flow and long periods. Learn more.

Adenomyosis

This is a condition where the glands from the endometrium (lining of the uterus) grow into the myometrium (wall of the uterus).

Use of hormone therapy

This can include certain types of birth control, such as pills or intrauterine devices, as well as hormone replacement therapy.

Certain types of gynecologic cancer as well as certain types of gynecologic infections. 

Diagnosis & treatment for abnormal uterine bleeding

How is abnormal uterine bleeding diagnosed?

Your healthcare provider will discuss your menstrual cycles with you at your visit. It is helpful to keep track of the details of your cycle with a calendar or phone app. Please note how often your cycles occur, the number of days your periods last, and how much bleeding you have (for example, heavy, medium, light, spotting).

To determine why you may be having abnormal uterine bleeding, your healthcare provider will perform a pelvic exam and may order tests, such as:

A urine pregnancy test

Testing for vaginal infections or sexually transmitted infections.

Endometrial biopsy

This is a biopsy of the endometrium (lining of the uterus), which is typically done to look for cancerous or pre-cancerous cells of the endometrium.

Ultrasound

This is an imaging test to look at the pelvic organs.

Saline infusion sonohystogram

This is an imaging test that involves injection of fluid into the uterus during an ultrasound. This will give your doctor a more detailed view of the inside of the uterus.

Hysteroscopy

This is a procedure where a small camera is placed through the vagina and into the lining of the uterus. This allows your doctor to see the inside of the uterus.

Can abnormal uterine bleeding be treated with medications?

Medications are the first-line option for treatment of most women with abnormal uterine bleeding. There are several medications that are used to treat abnormal uterine bleeding. These medications may include hormones, but there are also hormone-free medications if you are a candidate. Your healthcare provider will determine which medication is the best option for you based on the cause of the abnormal uterine bleeding.

Progesterone only therapy

Progesterone only pills or implants can be used to reduce the amount of bleeding during your period. They can also reduce the cramping associated with periods and pain from endometriosis.

Hormonal birth control

The birth control pill, patch, or ring can be used to reduce the amount of bleeding during your period and regulate the timing of your period.

Gonadotropin-releasing hormone agonists

These medications can reduce or stop the menstrual cycle. They may also help with pain associated with endometriosis and can be used to reduce the size of a fibroid.

Tranexamic acid

This is a non-hormonal medication that promotes clotting and can reduce the amount of bleeding during a period.

Non-steroidal anti-inflammatory drugs (NSAID)

These drugs include Motrin or ibuprofen and can help reduce heavy bleeding and relieve cramping during your period.

Antibiotics

Specific antibiotics are given if you are diagnosed with an infection.

Can abnormal uterine bleeding be treated with surgery?

If medication does not help with your cycles, your doctor may recommend a surgical procedure. 

Hysteroscopy with polypectomy or myomectomy

In this procedure, a camera is inserted through the vagina and into the uterine cavity. This procedure can be done to remove endometrial polyps or fibroids that are growing into the lining of the uterus.

Myomectomy

This procedure is done to remove a fibroid. If the fibroid is growing into the lining of the uterus, it can be removed without incisions with a hysteroscopy. If it is growing on the outside of the uterus, it can be removed with minimally invasive laparoscopic surgery or open abdominal surgery.

Endometrial ablation

This is a procedure that destroys the endometrium. This procedure can only be performed if you are done having children. Becoming pregnant after an ablation is high risk and may be life-threatening; your doctor will recommend effective birth control or sterilization for you or your partner if you choose to have an ablation.

Uterine artery embolization

In this procedure, the blood vessels to the uterus are blocked. This can be used to treat women with a fibroid.

Hysterectomy

This is the surgical removal of the uterus. This procedure can only be performed if you are done having children. You will not be able to get pregnant after this surgery, and you will no longer have periods. Your doctor may recommend this surgery if you have not responded to other treatments. 

Learn more

Why choose NGPG Gynecology?

NGPG is home to experienced providers you can trust. With four convenient locations across northeast Georgia, NGPG provides easy access and scheduling. Our approach to gynecologic services always centers care on the patient and family.

If surgery is necessary, we perfom our surgeries with state-of-the-art technology at Northeast Georgia Medical Center, providing our patients access to minimally-invasive laproscopic and robotic surgery options. By offering these options, we can minimize your stay in the hospital, shorten recovery times and reduce pain from surgery. NGMC Gainesville is the first hospital in Georgia to have received accreditation from the SRC as a Center of Excellence in minimally invasive gynecology. 

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