Abnormal Uterine Bleeding: Heavy, Long or Irregular Periods and Next Steps

What it involves

MedlinePlus describes abnormal vaginal bleeding as bleeding that is different from a normal period. It can be bleeding between periods, bleeding that is very heavy or lasts much longer than usual, and bleeding that happens before puberty or after menopause. Most menstrual cycles run about 28 days and a period usually lasts three to seven days, but cycles can be shorter or longer and still be normal.

Who this is for

• Women whose periods have become much heavier, longer or more painful than they used to be.
• Patients who bleed between periods or after sex.
• Women past menopause who notice any vaginal bleeding.
• Anyone feeling tired, dizzy or short of breath during periods who wants to check for anemia.

What to expect

• Questions about your cycle, how many pads or tampons you use, clots, and any changes in the past few months
• A review of your medicines, including birth control and hormone therapy, and a physical exam
• Blood work to look for anemia and thyroid problems, and a pregnancy test when it applies
• A referral for pelvic ultrasound or a gynecology visit when tests, a procedure or hormone treatment may be needed

What counts as abnormal bleeding

MedlinePlus lists the patterns that deserve attention: bleeding between periods, very heavy bleeding, bleeding that lasts much longer than usual, and bleeding after menopause. It also describes menstrual irregularities such as missed or infrequent periods, very heavy periods called menorrhagia, periods that regularly last longer than 8 days, and painful periods. Keeping a simple calendar of start dates, length and heaviness gives a provider real numbers to work with. Pain with periods is explored further in the endometriosis guide.

Common causes a provider looks for

MedlinePlus names uterine fibroids or polyps, hormone problems, hormone pills such as birth control pills or menopause hormone therapy, thyroid problems, and cancer of the cervix, ovaries, uterus or vagina. Because the list is wide, a provider starts with the likely and common causes and then rules out the serious ones. A condition that affects hormones and ovulation is described in the polycystic ovary syndrome guide, and the thyroid guide explains why a thyroid check is often part of the workup. Fibroids are one frequent cause, and the uterine fibroids guide explains their symptoms and treatment options in more detail.

Why heavy periods and tiredness go together

Long or heavy bleeding can use up the body's iron, and low iron can leave you pale, short of breath and worn out. Blood work is one of the services Serenity By A Dr. Sareen lists, and the anemia and low iron guide and the complete blood count guide explain how a provider checks for it. If you are dizzy when you stand, your heart races, or you faint, treat that as more urgent than a routine visit and use the sick visit, urgent care or ER guide to choose where to go.

How the cause is found

MedlinePlus says pelvic exams, blood tests, imaging tests and other procedures can help a provider diagnose the problem. A first visit usually covers your history, an exam and blood work. Pelvic ultrasound, sonohysterography and other tests are arranged by referral rather than done in the primary care office. Bleeding in pregnancy is its own situation: MedlinePlus says to contact a provider right away, because it is not always serious but should not be guessed at.

Treatment depends on the cause

According to MedlinePlus, treatment depends on the cause and can include medicines, hormones and surgery. A provider may adjust a medicine that is changing your cycle, treat an underlying thyroid or iron problem, or refer you to a gynecologist when fibroids, polyps or a procedure are on the table. Bleeding that returns after menopause always deserves a prompt visit, even when it is light. Heart and circulation questions that can come up alongside heavy bleeding are covered in the heart disease risk guide.

Sources

• MedlinePlus: Vaginal Bleeding (health topic)
• MedlinePlus: Menstruation (health topic)