By: DelCharco M.D. OB/GYN
Menstrual bleeding is a regular part of life for many women, but not all bleeding patterns are normal. Abnormal uterine bleeding (AUB) is a term used to describe menstrual bleeding that is irregular in timing, volume, or duration. While occasional variations may occur, persistent or severe symptoms warrant evaluation. At Dr. DelCharco’s practice, we help patients understand what constitutes abnormal bleeding, what causes it, and when it’s important to seek medical care.
Understanding these patterns empowers women to take charge of their health and get answers, not assumptions.
“The time taken to explain different birth control options and pros/cons. Taking a moment to hear my other health concerns and point me in the right direction to have them assessed by the proper physician. Overall very personable and compassionate. “
DelCharco M.D. OBGYN Patient Review
What Counts as Abnormal Uterine Bleeding?
Abnormal uterine bleeding may include one or more of the following:
- Heavy menstrual bleeding (menorrhagia): soaking through one or more pads or tampons every hour for several hours
- Prolonged bleeding: periods lasting more than 7 days
- Frequent periods: bleeding more often than every 21 days
- Infrequent or skipped periods: no bleeding for more than 90 days (outside of pregnancy or menopause)
- Bleeding between periods (intermenstrual bleeding)
- Post‑coital bleeding: bleeding after sex
- Postmenopausal bleeding: any bleeding after 12 months without a period
Any of these changes — especially if they impact daily life, cause discomfort, or lead to fatigue — should be taken seriously.
Causes of Abnormal Uterine Bleeding
Abnormal bleeding can stem from structural, hormonal, systemic, or pregnancy‑related causes. Sometimes, more than one factor contributes to symptoms.
1. Hormonal Imbalance
The menstrual cycle is regulated by a complex interplay of hormones, primarily estrogen and progesterone. When these hormones are out of balance, the uterine lining may:
- Build up excessively
- Shed irregularly
- Respond unpredictably to ovulation
This is especially common in:
- Adolescents with newly established cycles
- Women approaching perimenopause
- Women with conditions affecting ovulation, such as polycystic ovary syndrome (PCOS)
2. Uterine Fibroids
Uterine fibroids are benign (non‑cancerous) muscle tumors of the uterus. Depending on their size and location, fibroids can cause:
- Heavy menstrual bleeding
- Longer periods
- Pelvic pressure
- Painful periods
Fibroids are extremely common, particularly in women in their 30s and 40s.
3. Polyps
Endometrial polyps are growths in the lining of the uterus that can lead to irregular bleeding, including between periods and after intercourse. Polyps are usually benign but sometimes require removal for definitive evaluation.
4. Adenomyosis
Adenomyosis occurs when the inner uterine lining grows into the muscular wall of the uterus. This condition leads to a thickened uterus, heavier or prolonged bleeding, and painful menstrual cramps. It is most common in women in their 40s and 50s and can coexist with fibroids.
5. Pregnancy‑Related Causes
AUB can be related to pregnancy complications such as:
- Miscarriage
- Ectopic pregnancy
- Placental issues (in early pregnancy)
Any bleeding during pregnancy — even light or intermittent — should prompt immediate evaluation.
6. Bleeding Disorders
Some women have underlying clotting or bleeding disorders that affect how blood forms and stops. These conditions may reveal themselves as unusually heavy periods or prolonged bleeding. Examples include:
- von Willebrand disease
- Platelet function disorders
Women with a history of easy bruising, frequent nosebleeds, or a family history of bleeding disorders should mention this to their provider.
7. Thyroid Dysfunction
The thyroid gland influences metabolism and reproductive hormones. Both hypothyroidism (low thyroid function) and hyperthyroidism (high thyroid function) can disrupt menstrual cycles and lead to irregular bleeding.
8. Infections and Inflammation
Pelvic infections — such as pelvic inflammatory disease (PID) — can cause irregular bleeding, pain, and abnormal discharge. Prompt treatment is essential to prevent long‑term complications.
9. Medications and Contraceptives
Certain medications and hormonal contraceptives can affect bleeding patterns:
- Birth control pills, patches, rings, or hormonal IUDs may lead to spotting, especially in the first few months of use
- Anticoagulants (blood thinners) may increase bleeding volume or duration
If bleeding changes after starting a new medication, discuss it with your provider.
10. Endometrial Hyperplasia and Cancer
Endometrial hyperplasia — a thickening of the uterine lining — may cause abnormal bleeding and can be a precursor to endometrial cancer. While cancer is not the most common cause of AUB, it is critical to rule it out, especially in:
- Women over age 45
- Women with bleeding after menopause
- Women with risk factors such as obesity, diabetes, or a history of extended estrogen exposure
Symptoms That Should Prompt You to See a Doctor
Not all abnormal bleeding is emergent, but you should schedule a timely evaluation if you experience:
- Periods that interfere with daily activities
- Bleeding that requires changing protection every hour for several hours
- Bleeding that lasts more than 7 days
- Heavy clots or bleeding that causes weakness or fatigue
- Bleeding between periods
- Bleeding after intercourse
- Bleeding after menopause
- Dizziness, shortness of breath, or symptoms of anemia
If bleeding is accompanied by severe pain, fever, vomiting, or signs of pregnancy, seek prompt medical care.
What to Expect at Your Doctor Visit
When you call the office about abnormal uterine bleeding, your clinician will:
- Review your medical, menstrual, and reproductive history
- Ask about bleeding patterns — timing, volume, and associated symptoms
- Perform a pelvic examination
- Order blood tests (e.g., complete blood count, hormone levels)
- Recommend imaging, commonly a transvaginal ultrasound
- Consider a biopsy of the uterine lining when necessary
Accurate diagnosis is the first step toward effective, personalized care.
Treatment Options
Treatment depends on the underlying cause and your health goals. Options may include:
- Hormonal therapy (birth control, progestin therapy)
- Iron supplementation for anemia
- Minimally invasive procedures (polyps or fibroid removal)
- Endometrial ablation for heavy bleeding not responding to medication
- Treatment of underlying conditions (thyroid disease, bleeding disorders)
- Cancer‑directed therapy when indicated
Your provider will help you weigh benefits, risks, and expectations for each option.
“The office and staff were wonderful and treated me with respect and kindness, helping me to find a solution to my issues.”
DelCharco M.D. OBGYN Patient Review
Bottom Line: Don’t Ignore Abnormal Bleeding
Abnormal uterine bleeding affects many women, but it is not something to ignore or simply “put up with.” Whether it’s heavier, longer, or more frequent periods — or bleeding at unexpected times — understanding the causes and recognizing when to seek care can make all the difference in your long‑term health.
At Dr. DelCharco’s practice, we provide thorough evaluation and compassionate care to help you get answers and effective treatment. If you’re experiencing bleeding that feels different from your normal pattern, don’t wait — schedule an evaluation today.