Anovulatory bleeding; Abnormal uterine bleeding - hormonal; Polymenorrhea - dysfunctional uterine bleeding
Abnormal uterine bleeding (AUB) is bleeding from the uterus that is longer than usual or that occurs at an irregular time. Bleeding may be heavier or lighter than usual and occur often or randomly.
AUB can occur:
It does not occur during pregnancy. Bleeding during pregnancy has different causes. If you have any bleeding when you are pregnant, be sure to contact your health care provider.
Every woman's menstrual cycle is different.
For most women, female hormone levels change every month. The hormones estrogen and progesterone are released as part of the process of ovulation. When a woman ovulates, an egg is released.
AUB can occur when the ovaries do not release an egg. Changes in hormone levels cause your period to be later or earlier. Your period may sometimes be heavier than normal.
AUB is more common in teenagers or in premenopausal women. Women who are overweight also may be more likely to have AUB.
In many women, AUB is caused by a hormone imbalance. It can also occur due to following causes:
AUB is unpredictable. The bleeding may be very heavy or light, and can occur often or randomly.
Symptoms of AUB may include:
Other symptoms caused by changes in hormone levels may include:
A woman may feel tired or fatigued if she loses too much blood over time. This is a symptom of anemia.
Your provider will rule out other possible causes of irregular bleeding. You will likely have a pelvic exam and Pap/HPV test. Other tests that may be done include:
Your provider may recommend the following:
Treatment may include one or more of the following:
Your provider may put you on iron supplements if you have anemia.
If you want to get pregnant, you may be given medicine to stimulate ovulation.
Women with severe symptoms that don't improve or who have a cancerous or precancerous diagnosis may require other procedures such as:
Hormone therapy often relieves symptoms. Treatment may not be needed if you do not develop anemia due to blood loss. A treatment focused on the cause of the bleeding is often immediately effective. That is why it's important to understand the cause.
Complications that may occur:
Contact your provider if you have unusual vaginal bleeding.
The American College of Obstetricians and Gynecologists website. ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Reaffirmed 2020. www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/04/management-of-acute-abnormal-uterine-bleeding-in-nonpregnant-reproductive-aged-women. Accessed December 15, 2022.
Bahamondes L, Ali M. Recent advances in managing and understanding menstrual disorders. F1000Prime Rep. 2015;7:33. PMID: 25926984 pubmed.ncbi.nlm.nih.gov/25926984/.
Ryntz T, Lobo RA. Abnormal uterine bleeding: etiology and management of acute and chronic excessive bleeding. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 26.
Schrager S. Abnormal uterine bleeding. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn's Current Therapy 2023. Philadelphia, PA: Elsevier; 2023:1197-1198.BACK TO TOP
Review Date: 11/10/2022
Reviewed By: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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