Uterine bleeding, more commonly known as a menstrual period, is a fact of life for most women from the teen years into their 40s. This monthly event occurs when pregnancy doesn’t form and the uterine lining sheds and exits the body.
Menstrual bleeding typically lasts anywhere between two and seven days and occurs roughly once per month, but some women experience abnormal uterine bleeding, which can be disruptive and affect quality of life.
What is considered ‘abnormal’ uterine bleeding?
According to the American College of Obstetricians and Gynecologists, the normal menstrual cycle is between 21 and 35 days and a normal period lasts up to seven days. Anything outside of those norms can be considered abnormal.
Abnormal uterine bleeding includes:
- Any bleeding after menopause
- Bleeding or spotting after intercourse
- Bleeding or spotting between periods
- Heavy menstrual bleeding
- Irregular periods varying in length by more than seven to nine days
- Menstrual cycles longer than 35 days or shorter than 21 days
- Skipping a period for three to six months
What constitutes “heavy” bleeding? Menstrual bleeding is considered heavy if it soaks through one or more tampons or pads every hour, requires you to change your tampon or pad overnight, or lasts for longer than seven days.
What causes abnormal uterine bleeding?
Abnormal uterine bleeding can have many causes. For one, irregular periods and changes in bleeding are more common during times of hormonal transition, including when a girl first starts menstruating and during perimenopause.
Other causes of abnormal bleeding can include:
- Adenomyosis, where the uterine lining grows into the uterine wall
- Bleeding disorders
- Certain medications, including hormonal birth control
- Conditions affecting ovulation, including polycystic ovary syndrome or hypothyroidism
- Endometrial cancer
- Endometriosis, where the uterine lining grows in other pelvic organs
- Pelvic inflammatory disease
- Uterine fibroids or polyps
Abnormal uterine bleeding can also be caused by a miscarriage or an ectopic pregnancy, where a fertilized egg implants outside the uterus.
How is abnormal uterine bleeding diagnosed?
If you’re experiencing abnormal bleeding, a urogynecologist will first ask specific questions about the bleeding, including how long you bleed, how often you bleed, and any other symptoms you have.
Based on the information you provide, along with the findings of a physical and pelvic exam, your provider may then use many different tools to determine a diagnosis, such as:
- Blood tests to check blood counts and hormone levels
- Cultures to look for infection
- Endometrial biopsy, which takes a sample of the uterine lining and analyzes it for cancerous cells
- Hysteroscopy, a procedure that uses a small camera, inserted through the vagina, to provide images of the uterus
- Pelvic ultrasound to visualize the pelvic organs
- Saline infusion sonohysterogram, a type of ultrasound that involves injecting fluid into the uterus to capture more detailed views of the uterus
- Urine test to rule out pregnancy
These tests can help a urogynecologist determine the underlying cause of the abnormal uterine bleeding you’re experiencing and how it can best be treated.
How is abnormal uterine bleeding treated?
Because there are many different causes of abnormal uterine bleeding, there are also many different treatment options. An NGPG urogynecologist can help you find the treatment option or combination of treatments that will work best for you.
A treatment plan for abnormal bleeding may include:
Dilation and curettage
During this procedure, a urogynecologist removes tissue from the uterus, either as a diagnostic tool or to alleviate abnormal bleeding.
Endometrial ablation
During this procedure, a urogynecologist uses a laser, heat, electricity, microwave energy, or cold to destroy (or ablate) the uterine lining. Because it removes the lining, future pregnancy is dangerous, so this treatment option is usually paired with a long-lasting or permanent form of birth control.
Hysterectomy
During this procedure, a urogynecologist surgically removes the uterus. This treatment is usually recommended if other treatment options fail to provide relief, or if uterine or endometrial cancer is causing your abnormal bleeding.
Hysteroscopy
During this procedure, a urogynecologist removes fibroids (myomectomy) or polyps (polypectomy) from the uterus, guided by images provided by a camera inserted through the vagina and into the uterus. Myomectomy may also be performed as a standalone procedure.
Medications
A variety of medications may be used to alleviate abnormal bleeding, depending on the cause of the bleeding. This may include hormonal birth control, progesterone-only hormone therapy, gonadotropin-releasing hormone agonists, or tranexamic acid to reduce the amount of bleeding during periods.
If abnormal uterine bleeding is related to an infection, such as pelvic inflammatory disease, you may be given an antibiotic to clear the infection. NSAIDs, or non-steroidal anti-inflammatory medications, may also be recommended. These medications are well-known for alleviating period-related discomfort, but can also help reduce bleeding.
Uterine artery embolization
During this procedure, a urogynecologist inserts tiny particles called embolic agents into the arteries supplying the uterus with blood. These agents cut off blood flow to uterine fibroids, which causes them to shrink.
Choose NGPG for the treatment of abnormal uterine bleeding
NGPG urogynecologists offer unique expertise that combines both urology and gynecology, allowing them to treat conditions affecting the female pelvic floor. This includes many of the underlying causes behind abnormal uterine bleeding. Through NGPG Urogynecology, you can access a full spectrum of diagnostic and treatment options for abnormal bleeding, including surgery when necessary.
When surgery is necessary, it’s performed at Northeast Georgia Medical Center, where patients benefit from minimally invasive and even robotic surgical procedures when possible. These innovative techniques allow for a quicker recovery, reduced pain, and a lower risk of complications, getting you back to normal faster.
To request an appointment or to ask questions regarding our gynecologic services, treatments and office locations, please complete our online form or call one of our office locations.