One of the most common reasons for visits to the gynecologist is abnormal menstrual bleeding. And while you might be in good company with 10 million people affected by abnormal bleeding each year–it’s definitely not a party.

Typically, abnormal bleeding most often occurs during two big life stages: when a person starts having a period (puberty) and/or near menopause when periods begin to change before ceasing all together (perimenopause). Really, though, abnormal bleeding can happen at any time during a person’s reproductive life.

It can cause significant stress, discomfort and disruption—which is when you should see a doctor for it. Here’s what is considered abnormal menstrual bleeding:

  • Bleeding or spotting that occurs between periods
  • A menstrual cycle that is heavier and lasts longer than normal
  • Bleeding during or after sex
  • Bleeding that occurs around or after menopause

The most common causes of heavy bleeding are:

  • Pregnancy
  • Hormones
  • Fibroids, polyps and cervical lesions
  • Cancer
  • Bleeding disorders
  • No known reason

Bleeding during pregnancy

If you are of reproductive age and experiencing abnormal bleeding, one of the first things your provider will ask about is the possibility of pregnancy, especially if you’re not using contraception.

Many cases of bleeding may occur in early pregnancy, but bleeding can occur at any time during pregnancy and typically warrants evaluation. It can be a scary thing to experience, especially alone, so contact your provider’s office as soon as it happens.

Abnormal bleeding from hormonal imbalance

The most common reason for bleeding caused by hormonal abnormalities is typically related to a dysfunction of ovulation. Ovulation is that time of the cycle about two weeks before the start of your period when the ovary releases an egg.

Hormonal abnormalities are most common during those two stages mentioned above: puberty and perimenopause—when hormones are going full blast.

  • Puberty: When entering puberty, the communication between the brain (hypothalamus and pituitary gland) and the ovaries can be immature and may lead to irregular periods/bleeding.
  • Perimenopause: In this case, the signals to the ovary are intact, but because of the age-related effects in the ovary, it does not always release an egg in a timely fashion.

Other reasons for a dysfunction in ovulation may be related to different hormones, such as thyroid disorders. Your provider may perform lab tests as part of this evaluation to check various hormones and, if your bleeding is significant, indications of anemia.

Abnormal bleeding from fibroids, polyps and cervical abnormalities

Anatomic or structural abnormalities of the reproductive tract are another very common reason for abnormal bleeding. Bleeding that falls into this category may come from the cervix (where your doctor performs a pap smear), the lining of the uterus (which is shed every month during your period) or the body of the uterus.

Conditions such as fibroids, polyps and cervical abnormalities should all be evaluated.

  • Fibroids are benign tumors that can be common culprits in abnormal bleeding. Fibroids typically arise from the uterus and are composed of muscular tissue. Fibroids may also cause pain, pelvic pressure, urinary frequency, constipation and infertility.
  • Polyps are commonly benign growths found on the cervix or inside the uterus that often don’t cause any symptoms beyond abnormal bleeding.

A pelvic exam and ultrasound can detect most anatomic abnormalities. If the inside of the uterus needs to be further evaluated, your provider may also recommend a saline infusion ultrasound (SIS) or hysteroscopy. Both of these procedures are easily accomplished in the office.

  • SIS involves putting a small amount of saline (water) into the uterine cavity while performing an ultrasound to better define the endometrial cavity. This can help locate small polyps or fibroids that may be impacting your bleeding and/or infertility.
  • A hysteroscopy involves inserting a small camera into the uterus for the same purpose.

Abnormal bleeding as a sign of cancer

In severe (and more scary) cases, uterine cancer may be discovered as a result of abnormal bleeding. This is most common after menopause or during perimenopause.

Your provider typically evaluates this during an office visit by performing an endometrial biopsy, which is a test that samples the lining of the uterus. Certain risk factors, such as age, obesity, diabetes or chronic problems with ovulation may increase your risk of uterine cancer.

Abnormal bleeding caused by bleeding disorders and medications

Bleeding disorders or certain medications may contribute to abnormal menstrual bleeding, too. If you have a history of easy bruising, bleeding from your gums when brushing your teeth or bleeding excessively from a small cut, bring it up with your provider.

Be sure to mention if you are taking blood thinners for a medical condition, as sometimes this will cause heavy periods or bleeding mid-cycle during ovulation. Other medications that may cause abnormal bleeding are hormonal birth control methods and hormone replacement therapies.

Abnormal bleeding for no apparent reason

Once your provider looks into the possibility of the above conditions, they may conclude that all appears to be normal. While this result can feel frustrating, it’s actually quite common. But there are still many medical and surgical options available to address abnormal bleeding, especially if it’s affecting your life.

What are the potential complications of untreated abnormal menstrual bleeding?

It’s important to speak with your provider if you consistently experience abnormal menstrual bleeding. When the condition persists without investigating the cause, extreme complications can include anemia, infertility and endometrial cancer.

What are the treatment options for abnormal menstrual bleeding?

Treatment options for abnormal bleeding can be broken down into medical management and surgical options.

  • Medical options may include hormonal birth control pills, progestin medication, hormonal IUD, non-steroidal anti-inflammatory agents or adjustment to current medications.
  • Surgical options may include treatment for cervical lesions, polyps or fibroids.

If you’re wondering what you can do to alleviate menstrual pain and discomfort during abnormal bleeding episodes while at home, try:

  • Taking the recommended dose of NSAIDs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve). These can help reduce menstrual blood loss.
  • Placing a heating pad on your abdomen or soaking in a warm bath.
  • Engaging in physical activity like a moderate workout to release beta-endorphins.

If you experience abnormal menstrual bleeding and are interested in a consultation, please contact our office to schedule an appointment.