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Abnormal uterine bleeding

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If you are experiencing heavy periods, bleeding between periods, or menstrual cycles that feel irregular, you may have a condition called abnormal uterine bleeding (AUB). This is a common concern—and one our women’s health specialists are here to help you manage.

What is abnormal uterine bleeding?

Abnormal uterine bleeding refers to changes in the frequency, duration, regularity or flow of your menstrual cycle outside of pregnancy.

A normal menstrual cycle typically lasts 24–38 days, with bleeding lasting up to seven days. If your period is significantly heavier, lasts longer or comes too often — or too infrequently — you may be experiencing AUB.

How common is irregular menstrual bleeding?

About 1 in 3 people with periods experience irregular bleeding at some point, most often at the start of menstruation (menarche) or near menopause.

Causes of abnormal uterine bleeding

AUB can be linked to hormone imbalances, uterine growths, or other medical conditions. Doctors often use the PALM-COEIN system to describe causes:

  • P: Polyps – Noncancerous growths in the uterine lining, often causing bleeding between periods.
  • A: Adenomyosis – Endometrial tissue growing into the uterine muscle, causing pain and heavy bleeding.
  • L: Leiomyomas (Fibroids) – Benign uterine tumors that can cause heavy or prolonged periods.
  • M: Malignancy/Hyperplasia – Abnormal or cancerous growths in the uterus.
  • C: Coagulopathy – Blood-clotting disorders, affecting about 20% of women with heavy bleeding.
  • O: Ovulatory Dysfunction – Irregular or absent ovulation, often linked with polycystic ovary syndrome (PCOS).
  • E: Endometrial Causes – Inflammation, infection, or overgrowth of the uterine lining.
  • I: Iatrogenic – Medication side effects, including birth control or hormone therapy.
  • N: Not Classified – Rare causes such as post-surgical complications.

Symptoms of abnormal uterine bleeding

You may have AUB if:

  • Your period lasts longer than 7 days
  • Your cycles come closer than 21 days or farther apart than 35 days
  • You bleed heavily enough to pass large clots or soak through a pad or tampon every hour for more than 2 hours
  • You experience bleeding between periods or after sex

If you notice these symptoms, it’s important to schedule an appointment with your healthcare provider.

Diagnosis: How doctors evaluate AUB

Your provider will begin with a pregnancy test to rule out complications such as miscarriage or ectopic pregnancy. Additional steps may include:

  • Medical history & menstrual tracking
  • Physical exam – including thyroid and hormone checks
  • Pelvic exam & Pap smear – to check for infections, cervical changes, or polyps
  • Blood tests – to evaluate hormone levels and check for anemia
  • Ultrasound – to detect fibroids, polyps, or abnormal uterine lining
  • Hysteroscopy – to look directly inside the uterus and remove growths if needed
  • Endometrial biopsy – especially for women over 45 or with PCOS, to rule out endometrial cancer

Treatment options for abnormal uterine bleeding

Treatment depends on your age, overall health, and whether you want future pregnancies. Options may include:

Medications

  • Hormonal birth control (pills, patch, IUD) – regulate cycles, reduce bleeding, prevent pregnancy
  • NSAIDs (e.g., ibuprofen) – reduce bleeding and relieve cramps
  • Tranexamic acid – helps slow blood loss during heavy periods

Procedures & Surgery

  • Endometrial ablation – removes the uterine lining (not for women planning future pregnancies)
  • Myomectomy – removes fibroids while preserving fertility
  • Hysterectomy – removes the uterus; often a last resort when other treatments fail

Lifestyle Support

  • Weight management, diet changes, and exercise can improve symptoms—especially for women with PCOS.

Why it matters: Complications of untreated AUB

Chronic or severe abnormal bleeding can lead to:

  • Anemia (low red blood cells)
  • Infertility
  • Endometrial cancer (in some cases)

In rare cases, acute heavy bleeding may cause severe anemia, shock, or other life-threatening complications. If you experience very heavy bleeding, seek immediate medical care.

Take the next step

If you have irregular or heavy menstrual bleeding, don’t wait — abnormal uterine bleeding is treatable. Our women’s health specialists can provide the right diagnosis and treatment to help you feel better and protect your long-term health.