What causes abnormal uterine bleeding?

Most of the time abnormal bleeding is caused by ovarian dysfunction, especially in adolescents and women as they approach menopause. The uterine lining is stimulated by ovarian estrogen and progesterone. Fluctuations of these hormones will disrupt the normal process and can cause prolonged, irregular, or heavy bleeding.

However, approximately one third of women over 35 years of age with abnormal bleeding have uterine pathology such as:

• Fibroids: Tumors of the uterine muscle wall. They are almost always benign (not cancer), but as they enlarge they can distort the uterine cavity and interfere with the normal function of the uterus, causing the menstrual periods to become heavy, prolonged and more painful. Submucosal fibroids arise close to the uterine cavity and cause abnormal bleeding at smaller sizes than fibroids that occur further from the cavity.
  

  Submucosal fibroids arise close to the uterine cavity and cause abnormal bleeding at smaller sizes than fibroids that occur further from the cavity.

• Uterine polyps: Tumors of the uterine lining tissue origin, as they grow into the uterine cavity they can create abnormal bleeding.
• Cervical polyps: Like uterine polyps, they can cause abnormal bleeding.
• Adenomyosis: When tissue that looks like the lining of the uterine cavity is found in the muscle wall of the uterus, outside the cavity, it is called adenomyosis. It occurs in approximately 25% of women during their lifetime. Adenomyosis can cause heavier flow and worsening cramps.
• Cancer: This is more of a concern when abnormal bleeding occurs after the age of 50.

Some bleeding problems are due to blood and vascular abnormalities. Young women with heavy periods may have a problem with her clotting factors or platelets. If the internal vascular regulatory mechanisms of the uterus do not function properly then the small arteries that supply the uterine lining may not properly constrict at the time of the menstrual flow and lead to heavier periods.

How do I know if my uterine bleeding is abnormal? 

“Abnormal” bleeding means different things to different women, and no one knows your regular cycle better than you. However, here are some common symptoms of abnormal bleeding we see among our patients:

• Heavy menstrual bleeding, which means changing a pad or tampon with soak through every 2 hours or more.
• Periods that last longer than 7 days.
• Bleeding or breakthrough bleeding at times other than during your normal cycle.

What is my risk of cancer?

Usually when a woman presents with abnormal bleeding it is due to benign (not cancer) causes. In cases where the woman is around or beyond menopause, abnormal bleeding may be an early indication of uterine cancer. This should be evaluated with hysteroscopy and directed biopsy. In some cases, pre-cancerous conditions are found. Precancerous findings can be treated medically, and hysterectomy may not be required.

​What is the best way to diagnose abnormal uterine bleeding?

The first step in diagnosing abnormal bleeding is to take a look at your menstrual history. If your changes in flow are recent, this may indicate a fibroid or a polyp. If you’ve had a fairly heavy flow all your life, you may have hormonal or blood clotting problems. Irregular menstrual periods may be caused by ovarian dysfunction, especially in younger or older women.

The next step involves a physical examination and ultrasound. If the uterus is enlarged then fibroids may be present. Ultrasound utilizes sound wave technology to create an image of the uterus. Ultrasound will identify fibroids, polyps and adenomyosis.

You may need a diagnostic hysteroscopy procedure. A hysteroscope is inserted through the cervix to visualize and evaluate the uterine cavity and cervical canal for fibroids, polyps, and other pathologies that are too subtle for transvaginal ultrasound to detect. When there is a concern that cancer may be present diagnostic hysteroscopy with directed biopsies is more accurate than a D&C.

What is the best treatment for abnormal uterine bleeding?

There are several options for treating uterine bleeding depending on your circumstances. In some cases, the problem can be treated with medication, usually a contraceptive (oral or transdermal) or a prescription for the underlying condition causing the bleeding.

If the problem requires surgery, the Advanced Women’s Health Institute offers and recommends the most minimally-invasive surgical options available to you. Whatever you decide, we will work with you to develop a plan in which you are comfortable and confident.