Abnormal Periods

What causes abnormal bleeding or pain? Abnormal uterine bleeding and painful periods affect millions of people each year. While they are common, that doesn’t make them any less bothersome—or downright disruptive. Some of the most common causes of abnormal uterine bleeding include:

• Pregnancy: Light bleeding or spotting can be an early sign of pregnancy, but bleeding at any stage should be evaluated.
• Hormones: Often related to ovulation issues or an excess of prostaglandins (compounds that make the uterus contract), hormonal shifts are especially common during puberty and perimenopause.
• Fibroids, polyps and cervical lesions: These noncancerous growths in or on the uterus or cervix may lead to heavy or irregular bleeding, as well as pain or pressure.
• Endometriosis or Adenomyosis: Conditions where tissue similar to the uterine lining grows outside the uterus (endometriosis) or into the uterine wall (adenomyosis). These are common causes of severe menstrual cramps and chronic pelvic pain.
• Cancer: Though less common, uterine cancer can cause abnormal bleeding, pain or pressure, which is more typical after menopause or in the perimenopausal years.
• Bleeding disorders and medications: If you bruise easily or bleed heavily from minor cuts, a bleeding disorder could be a factor.
• No known reason: Sometimes, all tests come back normal. While that can be frustrating, it still helps guide us toward the right treatment.

No matter the cause, you don’t have to live with abnormal bleeding or excessive pain. We’re here to help you find solutions.

Not all abnormal bleeding needs to be addressed urgently. If you are having any kind of bleeding during pregnancy or following menopause—or are bleeding so heavily that you’re completely soaking through a maxi pad or super tampon every hour—then call our office. Our scheduling team may have you talk to an advice nurse to assess your situation and figure out next steps, which may include an urgent visit. If your abnormal bleeding doesn’t fall into one of these categories, then we’ll probably look for the next available appointment with a provider who has the skill and experience to address your concern.

At that visit, your provider will ask about your health history and your menstrual cycle. Keep track of your cycle before your visit, noting when you start your period, how long it lasts and how heavy it is. If pain is an issue for you, note its severity (on a scale of 1-10), what days of your cycle it occurs and what, if anything, makes it better or worse. Also, log any spotting you have between periods or after sex. 

Your visit will most likely include a physical exam, and your provider may also recommend blood tests, a pregnancy test and/or tests to screen for sexually transmitted diseases. Your provider may talk to you about having an ultrasound to fully evaluate your uterus and ovaries.

Treatment for abnormal uterine bleeding and/or menstrual pain is tailored to your needs and the underlying cause, but options generally fall into two categories: medication and surgical care.

Medication management may include:

• Hormonal birth control pills or the IUD to regulate your cycle, reduce bleeding and lessen painful cramps
• Progestin, a hormone therapy used to effectively reduce both heavy menstrual bleeding and severe period pain
• NSAIDs (non-steroidal anti-inflammatory drugs) to reduce bleeding and ease cramping
• Adjusting medications if a current prescription may be a factor

Surgical care might involve: 

• Removing fibroids, polyps or cervical lesions if those are found during evaluation and are believed to be causing abnormal bleeding or pain
• Minimally invasive surgery to diagnose and remove endometrial tissue with the goal of providing significant pain relief 
• Endometrial ablation if no cause can be found and you don’t want to become pregnant in the future
• Hysterectomy is an absolute surgical option only for those who don’t want to become pregnant in the future

If your periods are disrupting your life, you don’t have to tough it out. Schedule a consultation to explore what’s going on and how we can help.