The normal menstrual cycle lasts between 21 and 35 days. The normal period lasts about seven days. Abnormal uterine bleeding is common affecting 10%-30% of women of reproductive age. It is a common complaint in female adolescents, reproductive aged females, premenopausal, and perimenopausal women. It impacts the physical, emotional, sexual, and professional aspects of the lives of women, impairing their quality of life.

Any part of the female reproductive system can result in vaginal bleeding, including the uterus, vagina, vulva, and cervix. However, some abnormal vaginal bleeding may be caused by hemorrhoids, anal bleeding, or a urinary tract infection.

Acute abnormal bleeding is an episode of heavy bleeding that warrants immediate attention, and it is chronic when it has occurred for most of the previous six months. Abnormal uterine bleeding is a symptom, and it should be evaluated by Dr. Patel.

What is abnormal uterine bleeding?

Abnormal uterine bleeding is any bleeding that occurs outside of the normal menstrual cycle. This can include bleeding or spotting that occurs between periods, after sex, or after menopause.

It can also refer to heavier than normal menstrual bleeding. Heavy bleeding means soaking through one or more tampons or pads per hour, or bleeding that lasts more than seven days.

Abnormal bleeding can also be an irregular period where the cycle length varies more than 7-9 days, or not having a period for 3-6 months.

What are the causes of abnormal vaginal bleeding?

There are many potential causes of abnormal vaginal bleeding. Some common causes include:

• Hormonal imbalances, aging, and perimenopause
• Polycystic ovary syndrome (PCOS)
• Pelvic inflammatory disease (PID)
• Miscarriage or ectopic pregnancy
• Structural abnormalities include:
  • Uterine fibroids, also called leiomyomas
  • Polyps
  • Adenomyosis
  • Cervical or uterine cancer or hyperplasia
• Nonstructural abnormalities include:
  • Endometriosis
  • Bleeding disorders/clotting problems
  • Ovulation disorders

How is the cause of abnormal uterine bleeding determined?

Dr. Patel will take a detailed history and perform a pelvic exam. She will ask about previous surgical procedures, pregnancy history, medications, and birth control methods you use. She may ask you to tract your symptoms for several weeks. She will order lab tests including a pregnancy test and complete blood count, and tests for sexually transmitted infections. She may take a sample of endometrial tissues (endometrial biopsy) in patients 45 years of age and older, and in younger patients who have certain risk factors such as obesity. Transvaginal ultrasound is the preferred imaging modality, and it is indicated if a structural problem is suspected, or symptoms persist after appropriate treatment.

Other tests may include:

• Hysteroscopy – a thin lighted scope used to help Dr. Patel see inside the uterus
• MRI
• CT scan

What are the treatment options for abnormal uterine bleeding?

Medical and surgical treatment options are available. Emergency interventions for severe bleeding that causes instability include uterine tamponade, IV estrogen, dilation and curettage, and uterine artery embolization.

Medical management

To avoid surgical risks and preserve fertility, medical management is preferred initially. Common options include:

• Hormonal birth control for problems with ovulation, PCOS and fibroids
• Hormone therapy to treat heavy bleeding and other symptoms of perimenopause
• Drugs that can stop menstruation and reduce the size of fibroids, but these are only for short term use
• Tranexamic acid is a prescription medication to treat heavy menstrual bleeding
• Nonsteroidal anti-inflammatory drugs can help control heavy bleeding and relieve menstrual cramps
• Treatments for bleeding disorders
• Antibiotics for infections
• Studies report that the most effective long-term treatment for heavy menstrual bleeding is a hormone IUD

Surgical options

When medication doesn’t reduce bleeding, surgery may be necessary. The type of surgery depends on your diagnosis, your age, and whether you plan to become pregnant in the future.

• Endometrial ablation is a procedure to destroy the lining of the uterus to stop or reduce bleeding. After this procedure you must not become pregnant and will need to take birth control until after menopause or undergo permanent sterilization.
• Fibroid treatments that do not remove the uterus include MRI guided ultrasound surgery, surgical removal of fibroids and blocking blood flow to fibroids to stop fibroid growth.
• Hysterectomy is the procedure to remove the uterus.

Abnormal uterine or vaginal bleeding should be investigated. Contact Dr. Dwaita Patel to schedule a consultation.

Dr. Dwaita Patel is a board-certified obstetrician and gynecologist at City OB+GYN in New York City, and a fellow of the American College of Obstetrics and Gynecology (FACOG). She specializes in women’s health, and the full scope of gynecological services, including routine exams, contraceptive counseling, breast and ovarian cancer screenings, osteoporosis screening, premenstrual syndrome management, and more.

Dr. Patel is smart and kind and finds great joy and fulfillment in her work. She offers the full scope of obstetrics including pre-pregnancy, prenatal, labor and delivery and postpartum care for low and high-risk patients. She also offers medical treatments and minimally invasive surgery for gynecologic conditions. All deliveries and major surgeries are performed at Tisch Hospital/NYU Langone Medical Center in Manhattan.