By Mark D. Wild, MD, FACOG, South Carolina OB/GYN Associates

Normal menstrual bleeding can vary from person to person, so you may not be sure if what you’re experiencing is normal or abnormal. 

We refer to abnormal uterine bleeding as any unexpected or irregular bleeding from the uterus that deviates from your normal menstrual cycle pattern. It includes bleeding that is heavier in volume, lasts longer, or occurs outside the usual menstrual cycle. An example is menstrual bleeding lasting more than eight days per cycle. Abnormally heavy menstrual bleeding can lead to anemia, causing symptoms such as fatigue and decreased energy. Bleeding that requires you to change pads or tampons more than every hour or two is considered abnormally heavy.

Common causes of abnormal bleeding include structural abnormalities of the uterus or cervix, such as:

• Fibroids.
• Polyps.
• Adenomyosis.
• Uterine or cervical cancer or precancer. 

Other causes include ovulatory dysfunction or blood clotting disorders. 

There are many causes of ovulatory dysfunction, including thyroid disorders or hormonal imbalances, such as polycystic ovarian syndrome. Even extreme stress or intense exercise regimens can cause ovulatory dysfunction that leads to abnormal uterine bleeding. 

It is always important to rule out unexpected pregnancy if you are of reproductive age and experience abnormal bleeding. In reproductive-age women, especially those over age 35, see your OB/GYN for abnormal uterine bleeding that lasts longer than one cycle. If bleeding is extremely heavy and you have symptoms of anemia, seek an evaluation right away.

An OB/GYN evaluation will help identify the cause and develop a treatment plan. Treatment options depend on the cause of abnormal uterine bleeding and the severity of symptoms. Structural abnormalities such as fibroids or polyps are treated surgically or medically with hormonal therapy. Surgical treatments include hysteroscopy, laparoscopic myomectomy or hysterectomy, or endometrial ablation. 

We treat ovulatory dysfunction by identifying and correcting the underlying cause. An example of this would be treating a thyroid disorder causing irregular bleeding.

It is vital to be evaluated for abnormal uterine bleeding to ensure that there are no underlying causes that could affect the patient's overall health or cause harm. Then, you and your provider can discuss options and develop a treatment plan together.


Mark D. Wild, MD, FACOG, South Carolina OB/GYN Associates