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This topic is for women who
want to learn about or have been diagnosed with abnormal uterine bleeding
(AUB). Abnormal uterine bleeding has several causes. If you don't know what kind of
bleeding you have, see the topic
Abnormal Vaginal Bleeding.
Abnormal uterine bleeding (AUB) is irregular bleeding from the
uterus that is longer or heavier than usual or does not occur at your regular time. For example, you may have heavy bleeding during your period or in between periods.
Bleeding during pregnancy is a different problem. If you are pregnant and have any amount of bleeding from the vagina, be sure to tell your doctor.
Abnormal uterine bleeding has many causes. It is sometimes caused by changes in hormone
levels. It can also be caused by problems such as growths in the uterus or clotting problems.
In some cases the cause of the bleeding isn't known.
You may have abnormal
uterine bleeding if you have one or more of the following symptoms:
Before your doctor finds the cause of abnormal uterine bleeding, he or she must first make sure it's not vaginal bleeding from pregnancy or miscarriage.
Your doctor will ask
how often, how long, and how much you have been bleeding. You may also have a
pelvic exam, urine test, blood tests, and possibly an
ultrasound. These tests will help your doctor check for other causes of your
symptoms. He or she may also take a tiny sample (biopsy) of
tissue from your uterus for testing.
Let your doctor know if you have abnormal uterine bleeding. There are many ways to help treat it. Some are meant to return the
menstrual cycle to normal. Others are used to reduce bleeding or to stop
monthly periods. Each treatment works for some women but not others. Treatments
If you also have menstrual pain or heavy bleeding, you
can take regular doses of a nonsteroidal anti-inflammatory drug (NSAID), such
In some cases, doctors use
watchful waiting, or a wait-and-see approach. It may
be okay for a teen or for a woman nearing
menopause. Some teens have times of irregular vaginal
bleeding. This usually gets better over time as hormone levels even out. Women
in menopause can expect their periods to stop. They may choose to wait and see
if this happens before they try other treatments.
Learning about abnormal uterine bleeding:
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Abnormal uterine bleeding has many causes. These include:
In some cases the cause cannot be found.
abnormal uterine bleeding include:
Abnormal uterine bleeding often occurs before age 20 and after age 40.
No matter what your age, see your doctor
if you have irregular vaginal bleeding.
Risk factors (things that increase your
abnormal uterine bleeding include:
Some women have abnormal uterine bleeding even though
they have no risk factors.
If you have not been diagnosed with
abnormal uterine bleeding (AUB), see the topic
Abnormal Vaginal Bleeding to find out whether you
should see your doctor.
Any big change in
menstrual pattern or amount of bleeding that affects your daily life requires
evaluation by a doctor. This includes menstrual bleeding for three
or more menstrual cycles that:
Watchful waiting is a wait-and-see approach. If
you have been diagnosed with abnormal uterine bleeding, you may consider
watchful waiting when:
Talk to your doctor if you have not had a menstrual
period for more than 3 months.
Health professionals who can do an initial evaluation of a
vaginal bleeding problem include:
If you need to be seen for further evaluation or surgery,
your doctor may refer you to a gynecologist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor looks for a number of possible causes of your bleeding.
First, your doctor will:
If your symptoms are severe, your doctor
suspects a serious medical problem, or you are considering a certain treatment,
you may also have one or more other tests, such as:
Endometrial cancer risk increases with
age. Also known as uterine cancer, it is most common in women over age 50,
menopause. But endometrial cancer can also
develop earlier, during perimenopause or in women who have had abnormal
bleeding for many years.
It's important to let your doctor know if you have abnormal uterine bleeding. There are many ways to help treat it. Bleeding can usually be
managed with medicine to reduce bleeding and/or hormone therapy to either stop
or regulate menstrual periods. Surgical treatment is reserved for bleeding that
can't be controlled with medicine or hormone therapy.
bleeding is usually treated on an emergency basis with a short course of
estrogen therapy. If that isn't effective in rare
dilation and curettage (D&C) may be done to clear
the uterus of tissue. When needed, a
blood transfusion is used to quickly restore needed
If you are treated for severe uterine bleeding, you
and your doctor can then choose a treatment that is safe for the
Your age, the cause of
your condition, and any future plans for pregnancy will impact the treatment
choices available to you.
Gonadotropin-releasing hormone analogues (GnRH-As) are
rarely used now. These drugs reduce estrogen production, making your body think
it is in menopause. This reduces or stops menstrual periods for as long as you
take the medicine. After you stop taking the medicine, your symptoms will come
back unless you are close to menopause. Side effects with GnRH-As are common.
A medicine called tranexamic acid (such as Lysteda) is sometimes used for women who have bleeding that is heavier than normal. This medicine is not a hormone. It prevents bleeding by helping blood to clot. Talk to your doctor to find out if this option is right for you.
For more information about treatment options,
If you are thinking of getting treatment for
abnormal uterine bleeding, evaluate the following:
The answers to these questions will help you and your
doctor select the treatment plan that is best for you.
Sometimes hormonal changes cause abnormal uterine bleeding, so it cannot be prevented. But
being overweight can affect your hormone production, which increases your risk for irregular menstrual bleeding. If you are overweight, losing weight
may help prevent abnormal uterine bleeding.
You can use home treatment for some
problems related to
abnormal uterine bleeding.
menstrual pain and heavy bleeding, you can use a
nonsteroidal anti-inflammatory drug (NSAID), such as
over-the-counter ibuprofen. This type of medicine lowers
prostaglandins, which cause menstrual pain, and
reduces bleeding during your period. An NSAID works best when you start taking
it 1 to 2 days before you expect pain to start. If you don't know when your
period will start next, take your first dose of an NSAID as soon as bleeding or
premenstrual pain starts. Be safe with medicines, and follow your doctor's instructions.
Irregular menstrual bleeding can lead to low levels of iron in the blood.
This condition is known as
anemia. You can prevent
anemia by increasing the amount of iron in your diet.
Medicines often help treat abnormal uterine bleeding, and they have fewer risks than surgical treatment. If you
plan to become pregnant in the future, or if you are nearing the time when your
menstrual periods will stop (menopause), you may want to try
The goal of medicine
treatment for abnormal uterine bleeding is to reduce or eliminate blood
loss. This can be done in one or both of the following ways:
There are several hormone therapies for managing
abnormal uterine bleeding. These treatments help reduce bleeding and
regulate the menstrual cycle:
estrogen therapy is typically used when severe blood loss
must be quickly stopped.
Surgery is generally reserved for treating
abnormal uterine bleeding that can't be
controlled with medicine.
The following procedures are used to treat abnormal
Hysteroscopy may be done to
rule out serious uterine conditions:
Hysterectomy may be used as surgical treatment for abnormal
uterine bleeding when:
Regrowth of the endometrium may occur after you have endometrial ablation.
Fritz MA, Speroff L (2011). Abnormal uterine bleeding. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 591–620. Philadelphia: Lippincott Williams and Wilkins.
Lobo RA (2007). Abnormal uterine bleeding: Ovulatory
and anovulatory dysfunctional uterine bleeding, management of acute and chronic
excessive bleeding. In VL Katz et al., eds., Comprehensive Gynecology, 5th ed., pp. 915–931. Philadelphia: Mosby
Other Works Consulted
American College of Obstetricians and Gynecologists
(2007, reaffirmed 2009). Endometrial ablation. ACOG Practice Bulletin No. 81. Obstetrics and Gynecology, 109(5): 1233–1248.
American College of Obstetricians and Gynecologists
(2011). Intrauterine device. ACOG Practice Bulletin No. 121. Obstetrics and Gynecology, 118(1): 184–196.
Duckitt K, Collins S (2008). Menorrhagia, search date
October 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Goldstein SR (2008). Abnormal uterine bleeding. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 664–671. Philadelphia: Lippincott Williams and
Hillard P (2007). Benign diseases of the female
reproductive tract. In JS Berek, ed., Berek and Novak's Gynecology, 14th ed., pp. 431–504. Philadelphia: Lippincott Williams and
Kalan MJ (2010). Abnormal and dysfunctional uterine bleeding:
Treatment. In T Goodwine et al.,
eds., Management of Common Problems in Obstetrics and Gynecology, 5th ed., pp. 261–266. Chichester: Wiley-Blackwell.
Munro MG, et al. (2011). FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age.International Journal of Gynecology and Obstetrics, 113(1): 3–13. DOI: 10.1016/j.ijgo.2010.11.011. Accessed February 11, 2014.
Current as of:
May 10, 2014
Kirtly Jones, MD - Obstetrics and Gynecology & Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
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