By: DelCharco M.D. OB/GYN

Most women have had a period that felt “off” at some point: heavier than usual, longer than expected, or arriving at an unexpected time. But when does irregular bleeding cross the line from a one-time fluctuation into something that needs medical attention? Understanding what counts as abnormal uterine bleeding (AUB) is the first step toward getting the right care.

What Is Abnormal Uterine Bleeding?

Abnormal uterine bleeding is a broad term that covers any bleeding from the uterus that falls outside the range of what’s considered a normal menstrual cycle. A typical cycle runs anywhere from 21 to 35 days, lasts between 2 and 7 days, and involves a predictable flow. AUB includes anything that consistently deviates from this,  including:

• Bleeding between periods (intermenstrual bleeding or spotting)
• Periods that are heavier or longer than normal
• Periods that are unpredictable or have changed significantly in pattern
• Bleeding after sex
• Any vaginal bleeding after menopause

AUB is actually very common; it affects up to one in three women at some point during their reproductive years, yet many patients wait months or even years before seeking evaluation.

What Causes Abnormal Uterine Bleeding?

AUB can have many different causes, and pinpointing the underlying issue is key to choosing the right treatment. Common causes include:

• Hormonal imbalance: Fluctuations in estrogen and progesterone; often related to perimenopause, thyroid conditions, or polycystic ovary syndrome (PCOS) are among the most frequent causes of AUB.
• Uterine fibroids: These noncancerous growths in the wall of the uterus can cause heavy, prolonged periods and pressure or pain.
• Endometrial polyps: Small benign growths on the uterine lining that can cause irregular or heavy bleeding, especially after menopause.
• Adenomyosis: A condition where the tissue that normally lines the uterus grows into the uterine wall, leading to heavy, painful periods.
• Endometrial hyperplasia: A thickening of the uterine lining, often related to excess estrogen, that can increase the risk of uterine cancer if left untreated.
• Medications: Certain medications:  including blood thinners and some hormonal contraceptives can affect your bleeding pattern.
• Structural issues: Conditions like pelvic organ prolapse can sometimes be associated with irregular bleeding.

When Should You Call Your OB/GYN?

You should schedule an appointment with Dr. DelCharco if you experience any of the following:

• Bleeding that soaks through a pad or tampon every hour for several consecutive hours
• Periods that last longer than 7 days
• Spotting or bleeding between periods on more than one occasion
• Bleeding after sex
• Any bleeding after menopause
• Significant changes to a previously regular cycle

Don’t dismiss AUB as “just stress” or assume it will resolve on its own. While it often does have a benign cause, some causes of abnormal bleeding; like endometrial hyperplasia or, in rarer cases, uterine cancer are most successfully treated when identified early.

How Is Abnormal Uterine Bleeding Diagnosed?

The evaluation process typically begins with a conversation about your medical history, cycle patterns, and any other symptoms you’ve noticed. From there, your provider may recommend:

• A pelvic ultrasound to evaluate the uterus, ovaries, and uterine lining
• Blood tests to check hormone levels, thyroid function, and rule out clotting disorders
• A hysteroscopy or endometrial biopsy if the lining appears thickened or if polyps/fibroids are suspected: both of which can be performed through in-office surgery at our practice

Treatment Options for AUB

Treatment depends entirely on the cause and severity of the bleeding, as well as your age and whether you plan to have children. Options may include:

• Hormonal therapy: Birth control pills, the hormonal IUD, or other hormonal options can regulate or reduce bleeding for many patients. Dr. DelCharco offers comprehensive birth control counseling to help find the right fit.
• Endometrial ablation: A minimally invasive procedure that removes or destroys the uterine lining. Dr. DelCharco offers NovaSure® ablation as an in-office procedure: a one-time, five-minute treatment that dramatically reduces or eliminates heavy bleeding in over 90% of patients.
• Hysterectomy: For patients with severe, treatment-resistant AUB, a hysterectomy may ultimately be the most effective long-term solution.
• Hormone replacement management: For perimenopausal patients experiencing irregular bleeding related to hormonal changes, hormone replacement therapy may help stabilize hormone levels and reduce symptoms.

You Don’t Have to Just Deal With It

Abnormal uterine bleeding affects quality of life in ways that go far beyond the physical. It disrupts sleep, affects work and social plans, and takes a real toll on how women feel day to day. The most important thing to know is that effective treatment exists and it starts with an honest conversation with your OB/GYN.

If you’ve been putting off getting your bleeding evaluated, now is a great time to schedule that appointment. Dr. DelCharco and the team at DelCharco M.D. OB/GYN in Ocala, FL are here to listen, diagnose, and help you find relief.

Call us at (352) 690-6300 or schedule your appointment online.