What Causes the Uterus to Bleed?
Women of reproductive age bleed once a month during their menstrual period. This happens when your uterus sheds its lining, and the blood and tissue pass through the vagina and out of your body.
However, not all women experience this consistent, monthly uterine bleeding. Some women have infrequent or inconsistent periods. And some women will experience uterine bleeding after they’re past reproductive age and in menopause.
What Is Abnormal Uterine Bleeding?
Abnormal uterine bleeding is any menstrual cycle that varies more than expected in:
- frequency, or
Abnormal uterine bleeding may also include bleeding at unexpected times, such as after menopause.
Abnormal Uterine Bleeding Symptoms
The primary symptom is irregular bleeding, which may:
- occur more than every 21 days,
- occur less than every 38 days,
- last longer than seven days, or
- be so inconsistent you can’t predict it.
Other abnormal uterine bleeding symptoms may include:
- bleeding after sex,
- extreme fatigue,
- heavy bleeding or passing many clots during your period,
- painful periods, or
- spotting between periods.
Abnormal Uterine Bleeding Causes
Many different types of health conditions cause abnormal uterine bleeding, including:
- adenomyosis (your uterine lining grows into your uterus),
- endometrial hyperplasia (thick uterine lining),
- endometriosis (your uterine lining grows outside your uterus),
- fibroids or polyps (irregular growths in your uterus),
- hyperprolactinemia (excess prolactin, the hormone that stimulates milk production),
- polycystic ovary syndrome (PCOS), (a hormonal imbalance that leads to high levels of hormones called androgens), and
- gynecologic cancers.
Abnormal uterine bleeding can also arise from causes not directly related to your reproductive organs, such as extreme weight loss or thyroid conditions.
Uterine Bleeding After Menopause
Menopause occurs when a woman hasn’t had a menstrual cycle for at least 12 consecutive months. But some women have uterine bleeding after menopause. Common causes of bleeding after menopause include:
- atrophy (weakening) of the uterus from low hormones,
- endometrial hyperplasia,
- polyps, or
- hormone replacement therapy, a menopause treatment to adjust your hormone levels.
Gynecologic cancers can also cause bleeding after menopause. If you experience abnormal uterine bleeding after menopause, it’s important to see a health care provider for a diagnosis.
When to See a Gynecologist
An irregular cycle length or spotting between periods isn’t always a cause for concern. However, it may be time to see a gynecologist if you:
- bleed after menopause,
- experience abnormal uterine bleeding for more than one to two months, or
- have symptoms that interfere with your usual activities.
What to Expect during Your Gynecological Evaluation
Your gynecologist will conduct a medical exam and ask you questions about your symptoms, medical history, and lifestyle habits.
Based on your answers to these questions, your provider uses additional tests, including:
- blood tests to look for signs of polycystic ovary syndrome (PCOS) or thyroid problems,
- Pap smear to look for precancerous cells or changes in your cervix, or
- ultrasound to look for irregular growths or evaluate your uterine lining.
Your gynecologist will likely order an endometrial biopsy (a tissue sample of your uterine lining for lab analysis) if you are:
- over 45 or
- over 35 and have a history of PCOS or infrequent periods.
Women younger than 35 typically don’t need endometrial biopsies to diagnose abnormal uterine bleeding.
Abnormal Uterine Bleeding Treatment
Medication to Stop Abnormal Uterine Bleeding
Your treatment options will depend on the underlying cause of irregular bleeding. We often treat abnormal uterine bleeding with medications, such as:
- birth control pills to regulate your periods or decrease uterine bleeding,
- gonadotropin-releasing hormone (GnRH) agonists and antagonists to shrink fibroids or stop your menstrual cycle,
- nonsteroidal anti-inflammatory drugs (NSAIDs) to treat pain and reduce inflammation, or
- tranexamic acid to reduce heavy menstrual bleeding.
Progestin-releasing intrauterine devices (IUDs) also help decrease uterine bleeding and regulate periods.
Minimally Invasive Procedures
Simple, minimally invasive procedures can treat some problems, such as polyps or endometrial hyperplasia, including:
- hysteroscopy (procedure that uses a small lighted tool and surgical instruments to remove abnormal tissue or growths),
- uterine artery embolization (a small, flexible tool that sends tiny particles to block the blood vessels that supply blood to uterine fibroids), or
- laparoscopic myomectomy (technique to remove fibroids).
A hysterectomy (uterus removal) may be recommended for women who are past childbearing age or have no plans to have children in the future if other treatments aren’t an option.
Why Choose University of Utah Health?
At U of U Health, our Women's Health Services team provides comprehensive, nationally recognized top-quality care. We use advanced techniques and tools, many of which aren’t available elsewhere in the region, such as saline infusion sonograms and in-office hysteroscopy, which give our gynecologists a better view of the uterus.
We are one of just a few groups in the region using minimally invasive surgery techniques to remove uterine fibroids. Our team has more fellowship-trained minimally invasive gynecological surgeons on staff than anywhere else in the Mountain West region.