Every woman’s body, including their monthly menstrual cycle, is different. For example, some experience moderate cycles that last a full seven days, others may have shorter and lighter periods, and still others may experience heavy bleeding for more than seven days each month. While variation in bleeding can be normal, if bleeding occurs between monthly cycles, it can be a cause for concern.
According to the Journal of Endometrial and Uterine Disorders, abnormal uterine bleeding (AUB) involves bleeding that happens outside of the regular menstrual cycles. Symptoms include spotting or heavy bleeding on an unexpected basis, as well as severe pain and cramping.
AUB, also known as menometrorrhagia, is not uncommon. In fact, research published in the British Medical Journal estimates that the condition impacts between 20-50% of women at some point during their reproductive years. Review this brief guide to learn about the symptoms as well as the treatment options available.
Common Causes of AUB
The causes of abnormal uterine bleeding can vary, as they are related to a range of medical issues and even certain medications. According to the Mayo Clinic and the American College of Obstetricians and Gynecologists, these are some of the most common causes of AUB.
Hormonal Issues
Hormones play a significant role in uterine bleeding as they are the primary factor behind the regulation of menstrual cycles. Hormonal imbalances most frequently occur in women just beginning menstruation and those who are beginning menopause.
Hormonal imbalance and uterine bleeding are often intertwined, and an imbalance can result in one of the following causes of abnormal uterine bleeding:
Polycystic Ovary Syndrome (PCOS)
This common condition involves multiple cysts on the ovaries, impacting hormone balance by increasing androgen hormones. PCOS is one of the primary causes of irregular periods, decreased fertility, acne, facial hair growth, and thinning hair.
Thyroid Disorders
Thyroid disorders refer to any issues related to the thyroid that prevent it from creating hormones that impact the body’s major functions. Both hyperthyroidism (excessive thyroid hormones) and hypothyroidism (low thyroid hormones) can cause irregular periods, missed periods, or heavier/lighter bleeding.
Noncancerous Growths
Noncancerous (or benign) growths found in the uterus can also cause abnormal uterine bleeding.
In some cases, bleeding can result from growths that create a blockage; in others, the growth can bleed, resulting in AUB. Some kinds of growths that can happen in the uterus include:
Polyps
These growths are found in the inner lining of the uterus and are connected to the lining by either a thin stalk or a large base within the uterus. While they are usually benign, they can create issues with bleeding or fertility if they are not treated.
Fibroids
Uterine fibroids are a kind of noncancerous tumor found growing either in or on the uterus. Symptoms are not always experienced, but the most common include back pain, painful sex, frequent need to urinate, and heavy bleeding.
Endometriosis
Endometriosis refers to an inflamed inner lining of the uterus caused by infection. It can occur suddenly (acute endometriosis) and last only a short time, such as after birth, miscarriage, or surgery involving the cervix or uterus. Chronic endometriosis often occurs after menopause or after certain sexually transmitted infections.
Fortunately, benign growths can be addressed by your physician. Learn more about fibroid and endometriosis treatments.
Infections
Certain sexually transmitted infections (STIs) or other types of infections can result in abnormal uterine bleeding.
Some of the most common infections that can cause bleeding include:
Cervicitis
Most often caused by an STI, this infection occurs when the cervix has become irritated and inflamed. Some symptoms that may be experienced are pain during sex, unusual vaginal discharge, or irregular bleeding.
Chlamydia
This common STI can be spread through vaginal sexual intercourse, oral sex, or anal sex. As there are often no symptoms associated with chlamydia aside from irregular bleeding, regular screenings are suggested.
Urinary Tract Infections
UTIs aren’t an indicator of uterine bleeding but of an issue within the urinary tract itself. However, if you notice blood when wiping that occurs outside of your menstrual cycle, it may result from a UTI rather than uterine bleeding.
Medications and Devices
Some medications and medical devices that are meant to treat menstrual or bleeding issues can cause irregular or heavy uterine bleeding.
Medications may include:
- Blood thinners and aspirin
- Intrauterine devices
- Some kinds of birth control
- Tamoxifen, a drug used to treat breast cancer
Other Medical Issues
There are several other medical conditions that can also contribute to abnormal uterine bleeding.
These include:
Pregnancy
While light spotting can occur when the zygote is implanting during early pregnancy, heavier bleeding during late pregnancy can be the result of a serious complication like polyps, infection, placental abruption, or cervical insufficiency. If you are pregnant and begin bleeding, contact your healthcare provider right away.
Miscarriage
Progressively heavier bleeding during pregnancy can indicate a miscarriage. Miscarriage can result from an issue with the developing fetus or one of the issues above.
Ectopic Pregnancy
An ectopic pregnancy occurs when the embryo grows in the fallopian tube, which is not designed to support a growing fetus. Abnormal uterine bleeding can indicate an ectopic pregnancy.
Blood Clotting Disorders
Clotting disorders affect the body’s ability to control its clotting function, either producing excessive clots that don’t result from injury or excessive bleeding. A side effect of treatment for excessive clotting can result in heavy bleeding.
Abnormal Uterine Bleeding Symptoms to Watch For
Typical menstrual cycles can last anywhere between 21 and 35 days, beginning the first day of menstruation, when endometrial lining is shed from the uterus if an egg has not been fertilized. The period usually lasts between five to seven days.
Bleeding that occurs after the cycle has finished is considered abnormal. Other symptoms can indicate a serious underlying issue as well.
Symptoms that are important to watch out for include:
- Bleeding or spotting after a menstrual cycle
- Bleeding or spotting after having sex
- Bleeding after starting menopause
- Having a menstrual cycle lasting longer than 35 days or less than 21 days
- Irregular periods, including having a period more often than the 21-day cycle, and the cycle extending to longer than eight days
- Very painful menstrual cycles
- Experiencing extreme tiredness
- Experiencing symptoms of anemia, such as weakness and shortness of breath
Heavy Menstrual Bleeding
Heavy menstrual bleeding is a common way many women experience abnormal uterine bleeding.
Some symptoms include:
- Needing more than one sanitary napkin to contain the flow
- Soaking through one sanitary napkin each hour consistently throughout several hours
- Bleeding for longer than seven days
- Waking up throughout the night to change a sanitary napkin
- Having blood clots that are larger than the size of a quarter
- Feeling extreme fatigue or out of breath due to loss of blood
Periods that involve heavy bleeding and extreme cramping can make it very difficult for a woman to function normally. Suffering through painful and heavy periods does not have to continue, however, as heavy period treatments are available.
Uterine Bleeding After Menopause
Menopause refers to the time when a woman has stopped getting a monthly cycle for at least twelve months consecutively. Even though the menstrual cycle has finished in menopause, bleeding can still occur.
There may be several reasons for bleeding during and after menopause, such as:
- Weak uterus due to hormone deficiencies
- Endometrial hyperplasia
- Polyps
- Hormone replacement therapy
- Some kinds of cancers involving the female reproductive system
Uterine bleeding and menopause can occur at the same time, but it is typically a cause for concern, which is why it is important to seek medical attention. Seek comprehensive and compassionate care for menopause with Arizona Gynecology Consultants menopause services.
When to See a Doctor
Abnormal uterine bleeding can be alarming, but it is not always a reason to call your doctor. Certain symptoms, however, are indicative of a severe issue or an issue that has gone unnoticed and untreated.
Some signs of when to see a doctor for heavy bleeding include:
- Bleeding heavily and leaking through one sanitary napkin for more than two hours at a time
- Bleeding even after you have completed a menstrual cycle
- Bleeding or spotting after menopause
- Severe pain or cramping if you are not currently having a period
- Bleeding for longer than seven days
- Bleeding while also experiencing chest pain, dizziness, difficulty breathing normally, and fever
- Having periods at unpredictable times
- Bleeding while also experiencing anemia (including weakness or difficulty breathing)
Even if you don’t believe your symptoms are indicative of a severe issue, if they are making daily life difficult, discuss them with your doctor to pinpoint the cause and explore available treatments.
When to Seek Medical Attention for Abnormal Uterine Bleeding:
- Bleeding that occurs between menstrual cycles
- Heavy bleeding, including soaking through one pad every hour for several hours
- Bleeding after menopause
- Severe pain during or after a menstrual cycle
- Chest pain along with bleeding
- Fever while bleeding
- Dizziness as well as bleeding
Diagnosis and Treatment Options
While a diagnosis of menometrorrhagia (or abnormal uterine bleeding) can occur without a known cause, a physician must identify the cause to assess your treatment options. This means that they will need to review your medical history, consider your age, the symptoms you are experiencing, and whether you have any known conditions that can result in AUB.
Diagnostic Tests
The American College of Obstetricians and Gynecologists suggests a full medical history review as well as both a physical exam and pelvic exam.
Other diagnostic and exploratory tests may be needed, such as:
- An ultrasound
- A hysteroscopy
- An endometrial biopsy
- A sonohysterography ultrasound
- An MRI
Blood tests may also be necessary to determine whether you have an infection and to check your hormone levels. Additional biopsies may be necessary to eliminate the possibility of cancer.
Treatment Options
Depending on the cause of the bleeding, there are several different treatment options available.
Some of these treatments include:
- Hormonal regulation to promote regular menstrual cycles for those with ovulation issues.
- Birth control for those with consistently heavy periods
- Surgery, which can involve:
- Hysterectomy (removal of the uterus)
- Endometrial ablation (removal of the endometrium)
- Growth removal
Abnormal Uterine Bleeding FAQs
Abnormal uterine bleeding can cause valid concern. While we recommend consulting with your doctor about your specific issues, we’ve answered some commonly asked questions relating to AUB:
Schedule a Visit with Arizona Gynecology Consultants
Don’t ignore symptoms like heavy or irregular bleeding. Take control of your health and get answers with help from the professional team at Arizona Gynecology Consultants.
Our experienced team is here to guide you toward the best treatment options—schedule your visit today.
*Editor’s Note: This article was originally published April 2, 2017 and has been updated May 5, 2025.
Resources:
- Chen, M.-J., Luo, L., Liu, Y.-Y., Liu, M.-E., & Hsu, Y.-C. (2024). Heavy menstrual bleeding and outcomes in women: A narrative review. Taiwanese Journal of Obstetrics & Gynecology, 63(1), 7–13. https://doi.org/10.1016/j.tjog.2023.11.006
- Munro, M. G., Fraser, I. S., & Archer, D. F. (2022). Abnormal uterine bleeding in reproductive-aged women. BMJ, 378, e070906. https://doi.org/10.1136/bmj-2022-070906
- Mayo Clinic. (2022, January 18). Menorrhagia (heavy menstrual bleeding). Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829
- Cleveland Clinic. (2023, May 30). Menometrorrhagia (abnormal uterine bleeding). https://my.clevelandclinic.org/health/diseases/menometrorrhagia-abnormal-uterine-bleeding
- American College of Obstetricians and Gynecologists. (2021). Abnormal uterine bleeding. https://www.acog.org/womens-health/faqs/abnormal-uterine-bleeding
- Yale Medicine. (n.d.). Abnormal uterine bleeding. Yale University. https://www.yalemedicine.org/conditions/abnormal-uterine-bleeding
- University of Utah Health. (n.d.). Uterine bleeding. https://healthcare.utah.edu/womens-health/gynecology/uterine-bleeding
Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS
Dr. Kelly Roy is a specialist in surgical gynecology and advanced laparoscopy (and hysteroscopy). She is a long-time resident of Arizona and obtained her Bachelor of Science degree in Biomedical Engineering at Arizona State University before finishing her Doctorate of Medicine at the University of Arizona in 1997.
Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001.
Well known for her teaching and surgical ability, she is on the faculty at the residency program at both Banner University Medical Center and Saint Joseph’s Hospital in central Phoenix and is a Clinical Assistant Professor of Medicine at the University of Arizona College of Medicine, Phoenix Campus. Dr. Roy has taught advanced surgical techniques to medical students, residents, fellows and colleagues for over 15 years.
Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today.
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