Abnormal bleeding

If you are experiencing abnormal bleeding, it’s a good idea to talk to a health provider. Many of the most common causes of abnormal bleeding are not serious and are easy to treat. But others are more serious. A trained and certified women’s health provider can help determine which tests might be necessary to diagnose the cause of your bleeding and recommend an appropriate course of treatment.

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About abnormal bleeding

Abnormal uterine bleeding can be an alarming symptom for many women; however, it also happens to be extremely common. Roughly speaking, abnormal bleeding falls into three main categories:

  • Heavy bleeding (menorrhagia)
    • Changing protection required every two hours or less
    • Periods lasting longer than seven days each month
    • Passing large clots (quarter-sized or larger)
    • Menstrual cycles shorter than 24 days
  • Lack of menstrual bleeding (amenorrhea)
  • Irregular bleeding
    • Frequent spotting between periods
    • Heavy periods followed by light periods (or vice versa)
    • Menstrual cycles longer than 38 days
    • Irregular or unpredictable menstrual periods (cycle length varies by more than seven to nine days)
    • Missed periods

Abnormal or irregular uterine bleeding is often caused by fluctuations in hormone levels, including estrogen, progesterone and testosterone. These hormonal fluctuations may be due to something as simple as an unusual amount of stress. Or they may be due to the onset of menopause or a thyroid disorder.

Other causes of abnormal bleeding include fibroids (benign tumors that grow inside or outside the uterus), polyps (benign growths inside the uterus), problems with ovulation, endometriosis, adenomyosis, bleeding disorders, certain medications or pregnancy. Rarely, abnormal bleeding may be due to certain types of reproductive cancer, including cervical, endometrial and vulvar cancer.

Lifestyle tips

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  • Keep track of your menstrual cycle. Note the dates, length and type of flow you experience (light, medium, heavy or spotting) in order to determine what is normal for you and to keep track of any changes. Several smartphone apps are now available to track menstrual cycles.
  • If you’re experiencing heavy bleeding that often soaks through the protection you’re using and onto underwear or clothes, consider using a menstrual cup instead of a tampon or pad. Menstrual cups typically catch more blood than tampons or pads and require changing less often.
  • If you find yourself waking up during the night to change your pad or tampon, try wearing period panties to bed. These absorbent underpants catch blood like a pad and may be more comfortable than sleeping with a heavy pad.
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  • Drink plenty of water, especially when you are menstruating. Upping your water intake during heavy flow can help with fatigue and prevent dehydration.
  • Pay attention to your iron intake. Heavy bleeding can deplete the body of iron, leading to anemia. Good dietary sources of iron include beans, lentils, tofu, baked potatoes, cashews, dark green leafy vegetables (e.g., spinach), fortified cereals, clams, mussels, oysters, beef, pork, poultry and fish. Some women may need to take iron supplementation as well.
  • To maximize the amount of iron your body is absorbing, take a vitamin C supplement, or pair food high in iron with foods high in vitamin C—these include citrus fruits, leafy greens, bell peppers, strawberries, broccoli, tomatoes and tomato juice.
  • Limit your intake of alcohol and caffeine, especially if you are experiencing irregular bleeding or spotting in between periods. These substances can interact with the body’s production and release of estrogen and amplify any natural fluctuations that your body may be experiencing.
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  • Exercise regularly, at least 30 minutes at a time, three times a week. Regular exercise can help control estrogen and other hormones that regulate the menstrual cycle.
  • Maintaining a healthy weight can help reduce your risk of endometrial thickening and cancer.
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Get plenty of rest. The body needs energy to restore the blood it loses during heavy menstrual flow. Taking time to rest whenever possible is important—especially just before, during and after your period.

Stress management
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Relaxation techniques can curb stress that interferes with a woman’s natural cycle. Some proven techniques include deep breathing, guided imagery, mindfulness meditation, progressive muscle relaxation and yoga.

Treatment options

Treatments for abnormal bleeding vary, depending on the type and cause of the bleeding, your age and whether you want to have children. Medical therapies are usually the first line of treatment, and there are many surgical procedures to treat abnormal bleeding caused by structural abnormalities in the uterus.

Not sure where or how to get started? Our specialists are ready to listen. Schedule an appointment with an OB/GYN to get started.

Medical therapies
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  • Nonsteroidal anti-inflammatory drugs: These drugs, which include ibuprofen and naproxen, help to control heavy bleeding and relieve menstrual cramps.
  • Hormonal birth control: Birth control pills, patches and the vaginal ring contain hormones that can help regulate an irregular menstrual cycle or lighten menstrual flow.
  • Intrauterine device: A small device that is inserted and left inside the uterus to prevent pregnancy, an IUD can also reduce heavy bleeding that is not a result of fibroids or polyps that distort the shape or size of the uterus.
  • Gonadotropin-releasing hormone agonists: These drugs can stop the menstrual cycle and reduce the size of fibroids.
  • Tranexamic acid: This medication is prescribed to treat or prevent heavy bleeding.
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  • Operative hysteroscopy: Used to treat polyps or submucosal fibroids (fibroids that grow inside the uterus), this procedure requires no incision, as your surgeon accesses and removes the fibroids using instruments inserted through your vagina and cervix into your uterus.
  • Endometrial ablation: An option for women who are not concerned with preserving fertility, this treatment, performed with a specialized instrument inserted into your uterus, uses heat, microwave energy, hot water or electric current to destroy the lining of the uterus, either ending menstruation or reducing menstrual flow.
  • Uterine artery embolization: An option for women with fibroids who are not concerned with preserving fertility. In this procedure, the blood vessels to the uterus are blocked using small particles (embolic agents). These particles cut off blood flow to the fibroids, causing them to shrink and disappear. Complications are not common but may occur if the blood supply to the ovaries or other organs is impacted. Most women resume normal menstrual periods after the procedure.
  • Myomectomy: Used to treat fibroids, this surgical procedure removes the fibroids but not the uterus. There are several types of myomectomy available, including hysteroscopic, laparoscopic and robotic.
  • Hysterectomy: Surgical removal of the uterus. Hysterectomy is used to treat some conditions when other treatments have failed; it is also used to treat endometrial cancer. After the uterus is removed, a woman can no longer get pregnant and will no longer have periods.

Frequently asked questions

What qualifies as “abnormal” bleeding?
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“Normal,” of course, is a relative term. What might be cause for concern for one woman might be normal for another. That’s why menstrual pads and tampons come in different sizes and absorbencies. However, if you experience abrupt and unexpected changes to what you experience as normal—whether those changes consist of heavy bleeding, missed cycles or bleeding after sexual intercourse—it’s a good idea to follow up with your health provider.

What qualifies as “heavy” bleeding?
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If your periods last longer than seven days, or they come more frequently than every 24 days—measured from the start of one cycle to the start of the next—or if your bleeding requires you to change your pad and/or tampon more often than every two hours, it’s time to talk to a health provider. Prolonged heavy bleeding can lead to anemia, where the body doesn’t have enough healthy red blood cells to carry oxygen to all its tissues.

I thought I was done with menopause, but I just had my first period in over a year. Is this normal?
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Any postmenopausal woman experiencing uterine bleeding after one year without a period—or during or after sexual intercourse—should talk to her provider, as these types of bleeding can be caused by treatable vaginal infections or, in rare cases, certain forms of reproductive cancer.

Who gets abnormal bleeding?
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Abnormal bleeding can occur at any age. However, it is most common in teens and pre-teens ages 9-14, whose bodies are just entering their reproductive years, and in women ages 45-55, whose bodies are entering perimenopause.

What causes abnormal bleeding?
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Abnormal or irregular uterine bleeding is most often caused by fluctuations in hormone levels, including estrogen, progesterone and testosterone. These fluctuations may be caused by something as simple as an unusual amount of stress. Or they may be due to the onset of menopause or a thyroid disorder.

Other causes of abnormal bleeding include vitamin deficiency or eating disorder (which can result in amenorrhea, or a lack of menstrual periods), endometriosis, fibroids and polyps. Rarely, abnormal bleeding may be due to certain types of reproductive cancer, including cervical, endometrial and vulvar cancer.

How common is abnormal bleeding?
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About one in five women bleeds so heavily during her periods that she needs to put her normal life on hold. Blood loss during a normal menstrual period is about five tablespoons. Women with heavy flows can bleed as much as 10 to 25 times that amount each month.

Can abnormal bleeding indicate I have cancer?
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Abnormal uterine bleeding or discharge at any age could be a sign of several kinds of cancer. It’s the most common symptom in women with endometrial cancer. And bleeding after sex or between periods could be a sign of advancing cervical cancer. In older women, it could mean vulvar cancer.

Can abnormal bleeding cause infertility?
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While abnormal bleeding (outside pregnancy) rarely causes infertility, it often results from conditions that may in fact negatively impact fertility, such as endometriosis, fibroids or certain types of cancer.

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