By: DelCharco M.D. OB/GYN
Menstrual cycles can vary throughout a woman’s life, but significant changes in timing, duration, or amount of bleeding should never be ignored. Abnormal uterine bleeding (AUB) is one of the most common reasons women visit a gynecologist, and it can affect quality of life, energy levels, and overall health.
With spring transitioning into summer—bringing travel, outdoor activities, and busy schedules—many women become more aware of how unpredictable bleeding can disrupt daily life. The good news is that abnormal uterine bleeding is a treatable medical condition, and identifying the cause is the first step toward relief.
“Courtney was very kind, helped me feel informed and I felt like I was not rushed and could ask any ongoing questions. I’d love to continue my care with her.”
M DelCharco Jr. OB/GYN Patient Review
What Is Abnormal Uterine Bleeding?
Abnormal uterine bleeding refers to any bleeding from the uterus that differs from a typical menstrual cycle in frequency, regularity, duration, or volume.
A normal menstrual cycle typically:
- Occurs every 24–38 days
- Lasts 2–7 days
- Involves a moderate amount of bleeding
When bleeding falls outside these ranges—such as periods that are unusually heavy, prolonged, irregular, or occur between cycles—it may be classified as abnormal uterine bleeding.
AUB is very common. Studies estimate that up to one-third of women will experience abnormal uterine bleeding at some point in their lives, particularly during adolescence and the years leading up to menopause.
Signs You May Have Abnormal Uterine Bleeding
Some menstrual variation is normal, but certain symptoms may indicate a medical concern. Signs of abnormal uterine bleeding may include:
- Periods that last longer than seven days
- Bleeding between periods
- Very heavy menstrual flow
- Menstrual cycles that occur less than 21 days apart or more than 38 days apart
- Passing large blood clots
- Spotting after intercourse
- Sudden changes in your usual menstrual pattern
When bleeding becomes heavy or frequent, it can lead to iron-deficiency anemia, which may cause fatigue, dizziness, or shortness of breath.
Common Causes of Abnormal Uterine Bleeding
There are many possible reasons why abnormal bleeding occurs. Gynecologists use a classification system known as PALM-COEIN to categorize potential causes into structural and non-structural conditions.
Structural Causes
Structural issues involve physical changes in the uterus, such as:
- Uterine fibroids – benign muscle tumors in the uterus
- Endometrial polyps – small growths in the uterine lining
- Adenomyosis – when uterine lining tissue grows into the muscle of the uterus
- Endometrial hyperplasia or cancer
These conditions may cause heavy, prolonged, or irregular bleeding.
Hormonal or Functional Causes
Hormonal changes can also disrupt the menstrual cycle. Examples include:
- Ovulatory dysfunction (irregular or absent ovulation)
- Polycystic ovary syndrome (PCOS)
- Thyroid disorders
- Hormonal fluctuations during adolescence or perimenopause
When ovulation does not occur regularly, the uterine lining may build up excessively and shed unpredictably, causing heavy or irregular bleeding.
Other Contributing Factors
Additional causes may include:
- Blood clotting disorders
- Certain medications, including hormonal contraceptives or blood thinners
- Chronic medical conditions affecting hormone balance
Because abnormal uterine bleeding can have multiple causes, a thorough evaluation is essential.
When to See a Doctor
While occasional cycle changes can happen, persistent abnormal bleeding should be evaluated by a gynecologist.
You should schedule a visit if you experience:
- Bleeding that soaks through pads or tampons every 1–2 hours
- Periods lasting longer than a week
- Bleeding between menstrual cycles
- Symptoms of anemia such as fatigue or dizziness
- Bleeding after menopause
In some cases—especially when bleeding is severe—medical evaluation is needed to prevent excessive blood loss or identify more serious underlying conditions.
How Abnormal Uterine Bleeding Is Diagnosed
Diagnosis typically begins with a detailed discussion about your menstrual cycle, symptoms, and medical history. Your doctor may also recommend:
- A pelvic examination
- Blood tests to check hormone levels or anemia
- Ultrasound imaging to evaluate the uterus and ovaries
- Endometrial biopsy in certain situations
These tests help determine the underlying cause so the most effective treatment plan can be created.
Treatment Options for Abnormal Uterine Bleeding
Treatment depends on the cause of the bleeding, your overall health, and whether you plan to have children in the future.
Medical Treatments
Many cases of abnormal uterine bleeding can be managed with medication, including:
- Hormonal birth control to regulate cycles
- Progesterone therapy to balance hormones
- Anti-inflammatory medications to reduce bleeding
- Medications that help the blood clot more effectively
Minimally Invasive Procedures
If medication does not provide enough relief—or if structural conditions like fibroids or polyps are present—procedures may be recommended.
Common treatments include:
- Hysteroscopy, which allows doctors to view and remove polyps or small fibroids
- Endometrial ablation, a procedure that removes the uterine lining to reduce or stop menstrual bleeding
These procedures are often performed on an outpatient basis and can significantly improve symptoms.
Surgical Options
In severe or persistent cases, surgical treatments such as hysterectomy may be considered, particularly when other treatments have been unsuccessful.
“In my 62 years I have had two exceptional GYN doctors, she is one of the two. I appreciate her attention to detail and guidance through my hormone therapy journey. Not to mention her kindness.”
M DelCharco Jr. OB/GYN Patient Review
Take Control of Your Reproductive Health
Abnormal uterine bleeding is common, but it should never be dismissed as something you simply have to live with. Changes in your menstrual cycle are often your body’s way of signaling that something needs attention.
At DelCharco MD, patients receive compassionate, individualized care to identify the cause of abnormal bleeding and explore the most effective treatment options. With the right evaluation and care plan, many women can regain predictable cycles, improved energy, and peace of mind.
If you’ve noticed changes in your menstrual cycle or are experiencing heavy or irregular bleeding, scheduling an appointment may be the first step toward finding relief.