Abnormal uterine bleeding (AUB) describes any abnormal bleeding from the womb (uterus) that is a change from a woman’s normal menstrual cycle. This change may involve how often you get your period, how much blood you lose, and/or how long it lasts. You may also notice bleeding between your periods.
AUB is a common condition that affects up to one in three women of childbearing age.
If you are experiencing any uterine bleeding that is a change from your normal menstrual cycle, it is important to see your doctor. Even if your doctor cannot find a specific medical cause of the bleeding, treatments, such as anti-inflammatory medicines and hormone therapy, are available.
AUB affects every woman differently. For some women, AUB can be an ongoing problem that continues for months. For others, it can be a single, sudden episode of bleeding that may require immediate medical attention to stop the blood loss.
AUB symptoms may include:
AUB can be caused by many things. Causes of AUB include:
Your doctor will ask about your symptoms and their impact on your daily life and general health, and ask about your medical history, sexual history, any past pregnancies, family medical history, medication, and other factors before making a diagnosis of AUB.
Your doctor is also likely to examine you by:
You may be given the option to see a female doctor if this makes you feel more comfortable.
The tests usually performed to check for other causes include:
While unexplained bleeding can be distressing, treatment can stop the bleeding for most women.
A variety of strategies are used for AUB management. These focus on controlling the bleeding, returning your periods back to normal, and treating or preventing complications, such as anaemia.
If you are diagnosed with AUB, your treatment will depend on various factors, including:
When the exact cause of the bleeding is known, your treatment will aim to correct the specific cause. For example:
If your doctor is unable to identify a specific medical condition as the cause of your bleeding, five types of treatment can be used to manage the bleeding. These are:
Hormones, such as progestogens and oestrogens, can help to correct any reproductive hormone imbalance which may be contributing to your symptoms. These hormones can keep the menstrual cycle regular, and treat excessive menstrual bleeding.
The combined oral contraceptive pill is often used. Progesterone can help reduce heavy bleeding in women who do not ovulate regularly. It is available in different forms, such as oral tablets, implants, injection, or a progesterone-containing intrauterine system (IUS).
For some women, hormone therapy is not suitable. In this case, anti-inflammatory medications called non-steroidal anti-inflammatory drugs (NSAIDs) are used.
Examples of this medication include ibuprofen, mefenamic acid, and naproxen. These help to manage AUB symptoms by reducing the body's production of a hormone-like substance called prostaglandin.
Tranexamic acid may be prescribed by your doctor. It can slow the rate of blood loss by encouraging the blood in the uterus to clot.
If your bleeding is not responding to treatment, your doctor may recommend surgery.
If you do not plan to have children, an endometrial ablation (using heat or laser to remove part of the womb lining) or total removal of the uterus may be recommended.
If the bleeding is due to fibroids or polyps, these growths can be removed during a keyhole procedure called a hysteroscopy.
If your doctor considers your bleeding to be very heavy, you will need to be admitted to hospital for emergency treatment. Emergency care may involve fluids (given into your veins via a drip), medication, and, in serious cases, surgery as a last resort.
If you cannot have hormone treatment, surgery, or anti-inflammatory medication as part of your AUB treatment, your doctor may recommend a type of medication that suppresses your periods, called gonadotropin-releasing hormone (GnRH) analogues.
The risk of AUB complications depends on how long you’ve been bleeding and how severe the blood loss is.
The most common complications of AUB are:
Excessive or long-term blood loss can lead to iron deficiency anaemia in some women with AUB. This can be diagnosed easily by a blood test, and treated with iron tablets or iron given through a vein or into the muscle. More serious cases of anaemia may require a blood transfusion.
If AUB is left untreated for many years, the womb lining is at increased risk of abnormal growth. This can lead to a condition called endometrial hyperplasia (when the womb lining becomes abnormally thicker) which carries an increased risk of developing endometrial cancer.
AUB is a common condition which affects up to one in three women of childbearing age. It can be a distressing condition that has a big impact on your physical, social, and emotional quality of life.
If you are concerned that you may have AUB, you should see a doctor as soon as possible.
To find answers to any other health questions you might have, visit our Health A-Z.
Bestpractice.bmj.com. Dysfunctional uterine bleeding. 2017. Cited 15 November 2018.
Dynamed.com. Abnormal uterine bleeding. 2018. Cited 15 November 2018.
Nhs.uk. Heavy Periods. 2018. Cited 15 November 2018.
Patient.info. Menstruation and its Disorders. Menstrual disorders. 2016. Cited 15 November 2018.
Sogc.org. Abnormal bleeding in pre-menopausal women. 2013. Cited 15 November 2018.
UpToDate. Approach to abnormal uterine bleeding in nonpregnant reproductive-age women. 2018. Cited 15 November 2018.
Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.