It is normal for a woman's menstrual bleeding to last up to seven days and have bleeding occur every 21-35 days. Abnormal menstrual bleeding occurs when the menstrual period is not regular, bleeding lasts longer than normal, is heavier than normal, or when bleeding patterns change and becomes unpredictable.
There are many causes of irregular menstrual bleeding. The most common causes include polyps of the cervix or uterus, fibroids of the uterus, birth control pills, hormone usage, a lining of the uterus that is either too thick or too thin, and cancer. Your doctor may begin looking for the cause of abnormal bleeding by checking for problems most common in your age group.
To diagnose vaginal bleeding, your doctor will need to know your personal and family health history. You may be asked about:
- Past or present illnesses, past surgery
- Use of medications
- Use of birth control or hormones
- Weight, eating, exercise habits, and level of stress
You will have a physical exam. You also may have blood tests to check your blood count, hormone levels, and a pregnancy test (to see if you are pregnant). One or more of the following tests may also be needed based on your symptoms:
- Endometrial biopsy
- Dilation and curettage (D&C)
Most of these tests can be done in your doctor's office. Others may be done at a hospital or other facility.
Treatment for abnormal menstrual will depend on many factors, including the cause, your age, the severity of the bleeding, and whether you want to have children. Treatments include use of birth control pills or hormones, hysteroscopic removal of polyps or fibroids, endometrial ablation, and hysterectomy.
Your doctor may prescribe birth control pills to help your periods to be more regular. They also may improve other symptoms. Progesterone can help prevent and treat endometrial hyperplasia (abnormal thickening of the lining of the uterus).
Nonsteroidal antiinflammatory drugs, like ibuprofen and naproxen, may help control heavy bleeding.
Some women with abnormal menstrual bleeding may need to have surgery to remove growths (such as polyps or fibroids) that are causing the bleeding.
Endometrial ablation also is used to treat abnormal menstrual bleeding. Resection of the lining of the uterus, ablating it with cautery, or heating the inside of the uterus to close the blood vessels shut are excellent minimally invasive procedures to control abnormal uterine bleeding.
Hysterectomy, or the removal of the uterus, is another procedure that may be used to treat abnormal vaginal bleeding. This can be accomplished laparoscopically with very small incisions on your abdomen. This can also be done in the traditional "open" manner with a large abdominal incision. For those with pre-cancerous or cancerous change, a hysterectomy is standard. A hysterectomy is a major surgery.
If you notice that your menstrual cycles have become irregular, see your doctor. Abnormal bleeding has a number of causes. There is no way of telling why your bleeding is abnormal until your doctor examines you. Once the cause is found, abnormal bleeding often can be treated with great success using minimally invasive procedures in an outpatient or office setting.
Please call or email Dr. Alinsod if you have any questions regarding irregular menstrual bleeding.
This revised excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.
To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.