Normal menstrual periods occur no more frequently than very 21 days, last no longer than 7 days and require changing a pad no more frequently than every 4 hours or a tampon every 3 hours. Any vaginal bleeding which is more than this is considered to be abnormal and requires further evaluation and possible treatment.
Abnormal uterine bleeding (AUB) may be due to structural abnormalities of the uterus. Some of the more common structural causes of abnormal uterine bleeding include benign (non-cancerous) lesions of the uterus such as polyps, fibroids (myomas), and adenomyosis . Other causes include bleeding associated with early pregnancy, including miscarriage and ectopic pregnancy, and bleeding disorders which affect the ability of the blood to clot normally. Lesions of the cervix or vagina (benign and cancerous), chronic infections of the endometrial lining (endometritis), scar tissue ( adhesions) in the endometrium, and the use of an intrauterine device (IUD) may also be associated with abnormal uterine bleeding. Additional causes of abnormal bleeding include medications which can affect the normal release of estrogen and progesterone, chronic medical problems such as diabetes mellitus or disorders of the liver, kidney, thyroid gland, or adrenal glands, or other medical problems which can affect the production and metabolism of estrogen and progesterone. Emotional or physical stress as well as significant changes in body weight may disrupt the pituitary’s release of FSH and LH and prevent ovulation.
Dysfunctional uterine bleeding (DUB) is the occurrence of uterine bleeding unrelated to structural abnormalities of the uterus or the endometrial lining. It is a diagnosis of exclusion made after structural causes of bleeding and chronic medical diseases have been ruled out. Other causes of abnormal bleeding must also be disproved, including pregnancy complications and medications which influence hormonal action or affect clotting. DUB occurs most commonly in the first five years after a woman starts menstruating
and as she approaches menopausee. The main cause of DUB is anovulation, the absence of ovulation and the orderly secretion of estrogen and progesterone. DUB may alert the woman and her physician to the fact that she is no longer ovulating normally.
Evaluation of abnormal bleeding may require lab tests, ultrasounds or biopsies to determine the cause of the bleeding. Once the cause of the bleeding has been determined, you and your doctor will decide the treatment most appropriate for you.