By: DelCharco M.D. OB/GYN
Experiencing menstrual bleeding that is heavier, more irregular, or simply different from what you’ve experienced in the past can be confusing and disruptive. While variations in your cycle can sometimes be benign, abnormal uterine bleeding (AUB) — bleeding between periods, excessively heavy bleeding, or bleeding after menopause — deserves careful attention.
At DelCharco MD OB/GYN, we want to help you understand what abnormal uterine bleeding is, why it happens, and when it’s important to seek care. Being informed can empower you to take control of your reproductive health and make informed decisions with your provider.
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What Is Abnormal Uterine Bleeding?
Abnormal uterine bleeding refers to any pattern of bleeding that deviates from what is normal for you. This can include:
- Heavy menstrual bleeding: Soaking through a pad or tampon in an hour or less, needing to change products frequently, or bleeding that lasts more than 7 days.
- Irregular bleeding: Cycles that vary greatly in length or bleeding between periods.
- Unexpected bleeding: Spotting after intercourse, mid-cycle bleeding, or bleeding after menopause.
- Postmenopausal bleeding: Any bleeding that occurs after you’ve gone 12 months without a period.
AUB can affect women of all ages — from adolescents who are establishing their cycles to perimenopausal and postmenopausal women. Understanding the possible causes is the first step toward effective management.
Hormonal Imbalances: The Most Common Cause
Hormones act as the body’s cycle regulators. When the delicate balance between estrogen and progesterone is disrupted, the uterine lining may grow excessively or shed unpredictably.
1. Anovulatory Cycles
In some cycles, ovulation doesn’t occur. Without ovulation, progesterone isn’t produced in sufficient amounts, leading to prolonged estrogen stimulation and a thickened uterine lining that sheds irregularly and often heavily.
Anovulatory bleeding is common in:
- Adolescents within the first few years of menstruation
- Women approaching menopause (perimenopause)
- Those with significant stress or drastic weight changes
2. Thyroid and Other Endocrine Disorders
Thyroid disease — whether hyperthyroidism or hypothyroidism — can disrupt menstrual cycles. Other endocrine conditions like polycystic ovary syndrome (PCOS) also affect hormone balance and can cause irregular bleeding.
Structural Issues in the Uterus
Physical changes in the uterus or its lining can also contribute to abnormal bleeding.
1. Uterine Fibroids
Fibroids are non-cancerous growths in the muscular wall of the uterus that can cause:
- Heavy or prolonged periods
- Pelvic pressure or pain
- Bleeding between periods
The size and location of fibroids influence symptoms. Some women with fibroids experience significant bleeding, while others may not notice changes.
2. Adenomyosis
In adenomyosis, endometrial tissue grows into the muscular wall of the uterus. This can lead to:
- Heavy, painful periods
- Chronic pelvic pain
- Spotting between periods
Adenomyosis is more common in women in their 30s and 40s and can coexist with fibroids.
3. Polyps
Endometrial polyps are small, benign growths in the uterine lining that can cause irregular or heavy bleeding, especially between periods or after intercourse.
Pregnancy-Related Causes
Not all abnormal bleeding is related to reproductive system disorders.
- Miscarriage: Bleeding accompanied by cramping or tissue passage can signal early pregnancy loss.
- Ectopic Pregnancy: Bleeding with abdominal pain and dizziness should prompt immediate medical attention.
If there’s any chance of pregnancy, it’s important to rule this out early when evaluating abnormal bleeding.
Medications and Contraceptives
Certain medications can affect your bleeding patterns:
- Anticoagulants (blood thinners): Can make menstrual bleeding heavier.
- Hormonal contraceptives: Birth control pills, patches, rings, injections, and IUDs can cause irregular bleeding, particularly in the first few months as your body adjusts.
- Intrauterine Devices (IUDs): Copper IUDs may increase menstrual bleeding, while hormonal IUDs often reduce it over time.
If bleeding changes after starting or stopping a medication, it’s important to discuss this with your provider.
Infections and Other Conditions
- Pelvic inflammatory disease (PID): Infections of the reproductive tract can cause spotting or irregular bleeding.
- Sexually transmitted infections (STIs): Chlamydia and gonorrhea can lead to abnormal bleeding.
- Cancer: Rarely, endometrial or cervical cancer may present with abnormal bleeding, particularly postmenopausal bleeding.
Any bleeding after menopause should be evaluated promptly.
When to Seek Medical Evaluation
You should contact a healthcare professional if you experience:
- Bleeding that soaks through a pad or tampon in an hour or less
- Bleeding that lasts more than 7 days
- Spotting between periods that is persistent
- Heavy bleeding associated with dizziness, fatigue, or shortness of breath
- Any bleeding after menopause
At DelCharco MD OB/GYN, our team takes abnormal uterine bleeding seriously. We begin with a thorough history and physical exam, and we frequently use diagnostic tools such as lab work, ultrasound imaging, and, when appropriate, endometrial sampling to pinpoint the cause.
Treatment Options: Tailored to You
Treatment depends on the underlying cause and your goals, including:
- Hormonal therapies to regulate cycles
- Iron supplementation for anemia due to heavy bleeding
- Medications like tranexamic acid to reduce heavy flow
- Minimally invasive procedures for fibroids or polyps
- Surgical options in select cases
We work with you to choose a plan that aligns with your health needs and lifestyle.
“I thought that Paula was thorough, I understood the results and agreed with her for a six month check up. We agreed on further treatment and I was very pleased.”
M DelCharco Patient Review
Take Control of Your Cycle
Abnormal uterine bleeding can interfere with your quality of life and may signal an underlying condition that requires attention. Understanding the potential causes empowers you to seek timely care and make informed decisions about your health.
If heavy, irregular, or unexpected bleeding has affected you, DelCharco MD OB/GYN is here to help. We offer compassionate, personalized care and the latest in diagnostic and treatment options. Contact our office to schedule a consultation and take the first step toward better reproductive health.