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Abnormal uterine bleeding

Anovulatory bleeding; Abnormal uterine bleeding - hormonal; Polymenorrhea - dysfunctional uterine bleeding

Abnormal uterine bleeding (AUB) is bleeding from the uterus that is longer than usual or that occurs at an irregular time. Bleeding may be heavier or lighter than usual and occur often or randomly.

AUB can occur:

It does NOT occur during pregnancy. Bleeding during pregnancy has different causes. If you have any bleeding when you are pregnant, be sure to call your health care provider.

Images

Normal uterine anatomy (cut section)

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Causes

Every woman's period (menstrual cycle) is different.

For most women, female hormone levels change every month. The hormones estrogen and progesterone are released as part of the process of ovulation. When a woman ovulates, an egg is released.

AUB can occur when the ovaries do not release an egg. Changes in hormone levels cause your period to be later or earlier. Your period may sometimes be heavier than normal.

AUB is more common in teenagers or in premenopausal women. Women who are overweight also may be more likely to have AUB.

In many women, AUB is caused by a hormone imbalance. It can also occur due to following causes:

Symptoms

AUB is unpredictable. The bleeding may be very heavy or light, and can occur often or randomly.

Symptoms of AUB may include:

Other symptoms caused by changes in hormone levels may include:

A woman may feel tired or fatigued if she loses too much blood over time. This is a symptom of anemia.

Exams and Tests

Your provider will rule out other possible causes of irregular bleeding. You will likely have a pelvic exam and Pap/HPV test. Other tests that may be done include:

Your provider may recommend the following:

Treatment

Treatment may include one or more of the following:

Your provider may put you on iron supplements if you have anemia.

If you want to get pregnant, you may be given medicine to stimulate ovulation.

Women with severe symptoms that don't improve or who have a cancerous or precancerous diagnosis may require other procedures such as:

Outlook (Prognosis)

Hormone therapy often relieves symptoms. Treatment may not be needed if you do not develop anemia due to blood loss. A treatment focused on the cause of the bleeding is often immediately effective. That is why it's important to understand the cause.

Possible Complications

Complications that may occur:

When to Contact a Medical Professional

Call your provider if you have unusual vaginal bleeding.

Related Information

Vaginal bleeding between periods
Menopause
Endometrial cancer

References

American College of Obstetricians and Gynecologists website. ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Reaffirmed 2017. www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Management-of-Acute-Abnormal-Uterine-Bleeding-in-Nonpregnant-Reproductive-Aged-Women. Accessed October 27, 2018.

Bahamondes L, Ali M. Recent advances in managing and understanding menstrual disorders. F1000Prime Rep. 2015;7:33. PMID: 25926984 www.ncbi.nlm.nih.gov/pubmed/25926984.

Ryntz T, Lobo RA. Abnormal uterine bleeding: etiology and management of acute and chronic excessive bleeding. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 26.

Schrager S. Abnormal uterine bleeding. In: Kellerman RD, Bope ET, eds. Conn's Current Therapy 2018. Philadelphia, PA: Elsevier; 2018:1073-1074.

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Review Date: 9/25/2018  

Reviewed By: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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