Abnormal uterine bleeding is an incredibly common complaint in the world of gynecology. While it seems like we were created to experience our periods like clockwork each month and stop bleeding after menopause, that certainly is not always the reality. So why can abnormal bleeding occur, and what do we, as providers, do about it?
Let me break down the more common types of irregular bleeding we see and how we typically approach each individual issue. Keep in mind that all patients, providers, and situations are different and that this is not medical advice.
Heavy or prolonged bleeding prior to menopause:
There can be various causes of heavy, prolonged, and crampy bleeding. A benign cause assumed, we often treat most of these instances the same. Hormonal birth control is often our go-to treatment (surprise surprise!). The winners here? Birth control pills, the depo-provera shot, and the Mirena IUD. Pills can make periods lighter, regular, and less painful. The depo-provera shot and the Mirena IUD both come with a high likelihood that periods will stop all together. If you are not wanting contraception, a progesterone, like provera, can be used. This will help to regulate your periods while keeping the possibility of pregnancy open.
Bleeding after going through menopause:
Menopause (occurring around the average age of 51) is an all-but- enjoyable experience for most. Hot flashes, mood swings, and vaginal dryness are known all too well. The one benefit of menopause? No more periods. But what happens if you suddenly notice bleeding after a year or more of no periods? Well, this should be a red flag. As a provider, I tell all of my postmenopausal patients that any bleeding warrants a trip to see me. Why? Because it shouldn’t be happening, plain and simple. The first thing we want to rule out is uterine, cervical, or vaginal cancer. An EMB, or endometrial biopsy, is often performed along with an ultrasound and pap smear. The EMB gives us a sample of uterine tissue, providing us with important diagnostic information. Is this cancerous tissue or is it benign? Some providers may also do a pelvic ultrasound. This allows us to see the lining of the uterus: is it thick? Is there a polyp (a typically benign growth that can cause bleeding)? We want to get a good visual. Care from here is provider and result specific and patient guided. Bottom line: go get it checked out.
No periods after having had regular periods for some time:
If you are not on any hormonal birth control and have not had a period in over 6 months (and are not menopausal), make a trip to see your OB/GYN. We worry that without any shedding, the lining of your uterus may be growing too thick. Weight loss, stress, thyroid imbalances, pituitary imbalances, or hormone imbalances could be to blame. Often we will draw labs in order to rule out any potential causes and get an ultrasound to make sure that physically, everything looks OK. We want to find the cause and treat it from there. Typically, hormonal birth control pills or progesterone (if you do not want birth control) pills are used to initiate and regulate cycles.
Irregular bleeding while on hormonal birth control:
Irregular bleeding on birth control is so, so, so, SO common. Depending on the type of birth control you use, some adjustments can be made. Keep in mind that the first 3-6 months following the initiation of any form of hormonal birth control comes with irregular bleeding. It’s annoying, but it’s just how it goes (yay!). After that time, if you’re still experiencing irregular bleeding, contact your provider. Birth control pills can usually be adjusted to fix the issue. Other methods are harder to adjust, like the nexplanon or the IUD. Still, if you are frustrated, pay your provider a visit. These are just a few examples of the types of ‘abnormal uterine bleeding’ we commonly see. As always, if you are experiencing anything unusual, concerning, or just downright annoying, call your provider and pay them a visit.
Written by Kara Earthman, Women's Health CRNP and Founder of Karaearthwomen.