By: DelCharco M.D. OB/GYN
Abnormal uterine bleeding (AUB) — menstrual bleeding that is unusually heavy, prolonged, frequent, or irregular — is a common concern for many women. While occasional variations in menstrual patterns can occur throughout life, persistent or disruptive bleeding deserves medical evaluation. At Dr. DelCharco’s practice, we know that understanding your treatment options empowers you to make informed decisions and improves outcomes.
This article provides a comprehensive overview of current AUB treatment strategies, when they’re appropriate, and how they help restore health and quality of life.
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What Is Abnormal Uterine Bleeding?
Abnormal uterine bleeding refers to menstrual bleeding that falls outside typical patterns. It may include:
- Heavy menstrual bleeding (soaking through pads or tampons hourly)
- Prolonged bleeding (lasting more than 7 days)
- Frequent cycles (bleeding more often than every 21 days)
- Bleeding between periods
- Irregular bleeding that disrupts daily life
- Post‑coital bleeding or bleeding after menopause
AUB can result from hormonal imbalances, structural abnormalities, reproductive tract conditions, systemic diseases, or medication effects. Treatment is most successful when it is tailored to the specific cause, symptom severity, and individual health goals.
Goals of Treatment
The primary goals in treating AUB are to:
- Reduce menstrual bleeding and improve cycle regularity
- Alleviate symptoms such as anemia, fatigue, and pain
- Address underlying conditions (e.g., fibroids, polyps, hormonal imbalance)
- Preserve fertility when desired
- Improve quality of life
Achieving these goals often requires a combination of medical, procedural, or surgical approaches.
First‑Line, Non‑Surgical Treatment Options
1. Hormonal Therapies
Hormonal therapies are among the most commonly used treatments for abnormal uterine bleeding, especially when the cause is hormonal imbalance, ovulatory dysfunction, or endometrial thickening.
Combined Oral Contraceptives (Birth Control Pills)
- Regulate menstrual cycles
- Reduce menstrual flow
- Decrease cramping
- Offer contraception if desired
Birth control pills alter hormone patterns to stabilize the uterine lining, often leading to lighter, more predictable periods.
Progestin‑Only Therapies
- Oral progestins
- Injectable progestins
- Progestin‑releasing intrauterine devices (IUDs)
Progestins help control bleeding by thinning the endometrial lining. The levonorgestrel‑releasing IUD is an effective option for many women, providing continuous endometrial suppression and reducing heavy bleeding by up to 90% in some cases.
2. Non‑Hormonal Medications
For women who prefer to avoid hormones or for whom hormone therapy is not appropriate, non‑hormonal medications may help:
Nonsteroidal Anti‑Inflammatory Drugs (NSAIDs)
- Ibuprofen or naproxen
- Reduce menstrual blood loss
- Alleviate pain and cramping
NSAIDs work by reducing prostaglandin production, which contributes to heavy bleeding and menstrual pain.
Tranexamic Acid
- Taken only during heavy bleeding days
- Helps stabilize blood clots and reduces menstrual blood loss
Tranexamic acid is particularly effective for women with heavy flow who are not using hormonal contraception.
Minimally Invasive and Office‑Based Procedures
When bleeding persists despite medical therapy — or when structural issues are suspected — minimally invasive procedures may be appropriate.
3. Endometrial Ablation
Endometrial ablation is a procedure that removes or destroys the uterine lining to reduce or eliminate menstrual bleeding.
Who it’s for:
- Women with heavy bleeding who do not plan future pregnancies
- Patients who have not responded to medical therapy
Benefits:
- Performed in the office or outpatient setting
- Short recovery time
- Significant reduction in bleeding for many women
Limitations:
- Not suitable for women who want future fertility
- Not appropriate for all uterine abnormalities (e.g., large fibroids, high cancer risk)
4. Hysteroscopic Polypectomy or Myomectomy
If AUB is caused by uterine polyps or submucosal fibroids, removal via hysteroscopy — a minimally invasive, camera‑assisted technique — can reduce or resolve bleeding.
- Polypectomy: removal of benign polyps
- Myomectomy: removal of fibroids that distort the uterine cavity
These procedures preserve the uterus and are fertility‑sparing when fertility preservation is desired.
Surgical Treatment Options
5. Hysterectomy
For women with severe AUB that does not respond to medical or minimally invasive treatments — or when structural pathology (e.g., large fibroids, adenomyosis, or cancer) is present — a hysterectomy (removal of the uterus) may be recommended.
Benefits:
- Definitive treatment for heavy bleeding
- Eliminates the possibility of future uterine pathology
- Improves anemia and quality of life
Considerations:
- Not an option for women who desire future fertility
- Requires hospital stay and longer recovery than office procedures
Tailoring Treatment to Your Needs
Choosing the right AUB treatment depends on:
- Your age and reproductive goals
- Severity of bleeding
- Underlying diagnosis
- Response to prior therapies
- Overall health and preferences
Care becomes most effective when you and your provider design a plan that addresses both symptoms and root causes.
When to See a Doctor
It’s important to speak with a clinician if you experience:
- Bleeding that soaks through pads or tampons every hour for several hours
- Bleeding lasting more than 7 days
- Periods that are significantly heavier than usual
- Bleeding between periods
- Post‑coital bleeding
- Bleeding after menopause
- Symptoms of anemia (fatigue, dizziness, shortness of breath)
Even if bleeding seems light, persistent irregularity can indicate an underlying hormonal imbalance or structural change that benefits from evaluation.
What to Expect at Your Appointment
When you call Dr. DelCharco’s office with concerns about abnormal bleeding, the visit typically includes:
- Detailed symptom and medical history
- Pelvic examination
- Lab testing (e.g., hormone levels, anemia evaluation)
- Imaging such as transvaginal ultrasound
- Endometrial sampling when indicated
- Review of your individual treatment goals
From there, a personalized plan is created — whether that means medical therapy, procedural intervention, or surgical management.
You Deserve Answers and Relief
Abnormal uterine bleeding is a symptom with many potential causes — but it is treatable. Whether your goals include reducing heavy flow, preserving fertility, or simply reclaiming your quality of life, there are evidence‑based options that can help.
At Dr. DelCharco’s practice, our team provides compassionate, individualized care and helps you understand both why bleeding is happening and how best to treat it. If you’re experiencing menstrual changes that don’t feel “normal,” don’t wait — reach out today for an evaluation and expert guidance.