Abnormal Uterine Bleeding: When Your Cycle Goes Off Script
If you’ve ever been told you have abnormal uterine bleeding, you’re not alone. This is one of the most common reasons people see an OBGYN.
Hearing the word abnormal can immediately send your mind to worst‑case scenarios - and that’s understandable. But abnormal uterine bleeding does not always mean something bad has happened, and it definitely doesn’t automatically mean something serious.
What it does mean is that your bleeding pattern deserves a closer look.
This article is here to clarify the many different ways bleeding can be considered “abnormal,” what clinicians are thinking about when this comes up, and how abnormal bleeding is usually evaluated and managed — without panic.
What Is Abnormal Uterine Bleeding?
Abnormal uterine bleeding (often shortened to AUB) is an umbrella term. It doesn’t describe one single diagnosis - it describes bleeding that falls outside what’s expected for a typical menstrual cycle.
That can include many different patterns, such as:
- Regular periods that are heavier than average
- Regular periods with bleeding in between cycles
- Irregular or unpredictable periods
- Bleeding after sex
- Bleeding that lasts much longer than usual
In other words, abnormal simply means different from what’s expected.
A Note About Postmenopausal Bleeding
Bleeding after menopause, also called postmenopausal bleeding, is an entirely different issue with a different set of causes and a different evaluation.
If you’ve gone 12 months without a period and then experience bleeding again, that pattern requires separate attention and workup. We review postmenopausal bleeding in more depth in its own article.
What’s Considered “Normal” Bleeding?
There’s a wide range of normal when it comes to menstrual cycles. We review the menstrual cycle in depth in *Your Monthly Programming: How the Menstrual Cycle Works*, but as a general overview, many clinicians consider the following typical:
- Cycles occurring every 21–35 days
- Bleeding lasting about 3–7 days
- A flow that’s manageable without soaking through pads or tampons every hour
That said, all bodies are different. If you’re unsure whether your bleeding pattern is normal for you, or if something has changed, it’s reasonable to check in with a provider.
Common Causes of Abnormal Uterine Bleeding
Clinicians often think about abnormal uterine bleeding using a framework called PALM‑COEIN. This helps organize possible causes into two broad groups:
- Structural causes: a physical condition affecting the uterus
- Non‑structural causes: things like hormonal imbalances or other factors that affect bleeding but can’t always be seen on imaging
Structural Causes (PALM)
- Polyps
- Adenomyosis
- Leiomyomas (fibroids)
- Malignancy or pre‑malignancy
These involve physical changes in the uterus itself.
Non‑structural causes (COEIN)
- Coagulopathy (bleeding or clotting disorders)
- Ovulatory dysfunction — irregular or absent ovulation, such as in conditions like PCOS
- Endometrial causes — when the uterine lining doesn’t function normally despite no visible structural issue
- Iatrogenic causes — bleeding related to medications or medical devices
- Not otherwise classified
Hormonal imbalances, stress, weight changes, and life transitions (such as postpartum or perimenopause) often fall into the non‑structural category.
It’s also important to know:
- You can have more than one cause at the same time
- The same diagnosis can present differently in different people
- This framework reflects how clinicians think - not a rigid checklist
How Doctors Evaluate Abnormal Uterine Bleeding
Evaluation usually starts with the basics and builds from there.
This may include:
- A detailed history of your cycles and symptoms
- Blood work (including checks for anemia or hormonal patterns)
- Imaging, such as a pelvic ultrasound
- In some cases, sampling the uterine lining, depending on age, symptoms, and risk factors
Not everyone needs every test. The evaluation is individualized.
When to Seek Care Urgently
Most abnormal uterine bleeding isn’t an emergency — but there are times when it shouldn’t wait.
You should contact your doctor or seek urgent care if you have:
- Bleeding so heavy that you’re soaking through a pad or tampon every 1–2 hours
- Symptoms of significant anemia, such as dizziness, fainting, shortness of breath, or chest discomfort
- Severe weakness or feeling like you might pass out
Heavy bleeding can lead to significant anemia and strain on the body. Getting help early matters - even if that means going to the emergency room.
How Is Abnormal Uterine Bleeding Treated?
Treatment depends entirely on the underlying cause.
Broadly, management may include:
Hormonal medications:
Pills, patches, rings, injections, or IUDs can help regulate cycles and reduce bleeding for many people.
Non‑hormonal options:
Some medications reduce menstrual blood loss without affecting hormones.
Procedures or interventions:
When structural causes are involved, procedures may be recommended. These range from minimally invasive treatments to surgery, depending on the situation.
Many of these options are reviewed in more depth in other Femanual articles, and treatment is tailored to your goals and symptoms.
The Bottom Line
Abnormal uterine bleeding doesn’t automatically mean something dangerous - it means there’s a pattern worth understanding.
With the right evaluation, most causes can be identified and managed. Asking questions and seeking care is appropriate, and you don’t need to figure this out on your own.
Common Questions About Abnormal Uterine Bleeding
Is heavy bleeding normal?
- Heavy periods are common, but they aren’t something you have to live with — especially if they affect your quality of life.
Why am I bleeding between periods?
- This can be related to ovulation patterns, hormones, polyps, or other uterine conditions.
Can stress cause abnormal bleeding?
- Yes. Stress can disrupt ovulation and hormone signaling, which can affect bleeding patterns.
What tests will my doctor order?
- That depends on your age, symptoms, and risk factors. Many people don’t need extensive testing.
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