Abnormal Uterine Bleeding

Abnormal uterine bleeding can be characterized as either too much or too little bleeding. The most common type of abnormal uterine bleeding (also called dysfunctional uterine bleeding) is menorrhagia. Menorrhagia is experienced when there is excessive and possibly prolonged uterine bleeding. Although the amount of menstrual flow is somewhat subjective, women with menorrhagia often have a difficult time doing their daily activities. They may soil their clothes and bleed through protection. Some women may even become anemic due to excessive menstrual blood loss. Different types of abnormal uterine bleeding include:

Menorrhagia: Heavy or prolonged bleeding
Metrorrhagia: Any irregular bleeding between periods
Polymenorrhea: Bleeding is typically closer than 21 days
Oligomenorrhea: Periods are skipped or very light
Postmenopausal Bleeding: Bleeding that occurs a year after the last menstrual cycle at menopause

Causes for Abnormal Uterine Bleeding

  • Hormonal Changes
  • Uterine Fibroids
  • Adenomyosis
  • Abnormal Pregnancy (i.e., miscarriage, ectopic)
  • Uterine Polyps
  • Birth Control Methods
  • Pelvic Inflammatory Disease
  • Hematologic Disorders
  • Liver, Kidney or Thyroid Deisease

Generally, menorrhagia or menstrual bleeding is considered excessive when women bleed through sanitary protection in an hour. Prolonged bleeding occurs when a period lasts longer than seven days.

The symptoms of menorrhagia may resemble other menstrual or medical problems. It is best to see your provider for the appropriate diagnosis.

The evaluation evaluating menorrhagia and other abnormal uterine bleeding problems includes a complete history and pelvic exam.
Tests that may be recommended include:

  • Blood Tests (check for anemia and hormaonal levels)
  • Pap Test (screen for cerix cancer)
  • Ultrasound (evaluate anatomic abnormalities such as fibroids and polyps)
  • Biopsy (endometrial) An endometrial biopsy removes tissue from the lining of the uterus. This is typically performed in the office.
  • Hysteroscopy A visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.
  • Dilation and Curettage (D&C) This is a minor gynecological surgery which involves the widening the cervical canal with a dilator and scraping the uterine cavity with a curette.

Treatment Options for Menorrhagia

Treatment for menorrhagia and other types of abnormal uterine bleeding are decided between the patient and the healthcare provider once the workup for possible underlying causes is complete. The best treatment is determined based on several factors including the reason for your bleeding along with your age and interest in future pregnancy.

  • Iron supplementation. This treatment is used if the condition is coupled with anemia. A blood disorder caused by a deficiency of red blood cells.
  • Tranexamic Acid. A man-made from of an amino acid called lysine that works to slow bleeding by stabilizing blood clot formation. This medication is only taken when the heavy bleeding is occurring.
  • Prostaglandin inhibitors. These are nonsteroidal anti-inflammatory medications, including ibuprofen and aspirin, which not help decrease the cramping, but also the amount of blood flow.
  • Oral contraceptives. Thins lining of the uterus and suppresses ovulation.
  • Progesterone. Hormone treatment that can thin the lining and reduce bleeding.
  • Levonorgestrel-releasing Intrauterine system (Mirena IUD). The IUD can be used for cycle control and/or for birth control.
  • Endometrial ablation. A procedure to destroy the lining of the uterus (endometrium)
  • Hysterectomy. A surgical removal of the uterus.