Understanding Abnormal Uterine Bleeding: What It Is, Why It Happens, and When to Seek Care
- Posted on: Apr 6 2026
By: Grace Obstetrics & Gynecology in Fort Worth and Granbury, TX
For many women, menstrual patterns are a predictable part of life. But when bleeding becomes unusually heavy, irregular, or prolonged, it can disrupt daily activities and signal an underlying health issue. This is what clinicians refer to as abnormal uterine bleeding (AUB) : a common concern that affects women of all ages and life stages.
At Grace Obstetrics & Gynecology in Fort Worth and Granbury, TX, we understand that changes in your period can be both physically challenging and emotionally unsettling. Our goal is to help you recognize what’s normal versus what warrants a closer look, and to provide compassionate, evidence-based care every step of the way.
What Is Abnormal Uterine Bleeding?
Abnormal uterine bleeding refers to bleeding from the uterus that is different in timing, duration, or volume from your typical menstrual cycle. While there’s no one “normal” cycle length or flow for all women, bleeding may be considered abnormal if:
- It’s heavier than usual or requires frequent pad/tampon changes
- It occurs more often than every 21 days or less often than every 35 days
- The bleeding lasts longer than 7 days
- You experience spotting between periods or bleeding after intercourse
- Bleeding occurs after menopause
Spotting and irregular cycles aren’t always harmful but when the patterns change from what’s typical for you, discussion with your care provider can help rule out serious conditions and prevent complications.
Why Abnormal Uterine Bleeding Happens
Abnormal bleeding can arise from a number of causes, some related to normal biological transitions and others linked to structural or hormonal issues. Common factors include:
1. Hormonal Imbalances
The menstrual cycle is driven by the complex interaction of hormones such as estrogen and progesterone. When ovulation doesn’t occur (a condition called anovulation), the usual hormonal rhythm is disrupted and can lead to unpredictable bleeding. This is especially common during:
- Adolescence
- Perimenopause (the transitional years before menopause)
- Conditions like polycystic ovary syndrome (PCOS)
Hormonal imbalances can also be related to thyroid disorders or abrupt changes in weight and stress.
2. Uterine or Cervical Structural Changes
Structural abnormalities within the reproductive tract can directly affect bleeding patterns. These include:
- Uterine fibroids – benign muscle tumors that can enlarge the uterus and increase bleeding
- Endometrial polyps – localized overgrowths of the uterine lining
- Adenomyosis – where endometrial tissue grows into the uterine muscle
- Polyps or lesions of the cervix or vagina
- Infections such as pelvic inflammatory disease (PID)
3. Serious Conditions
Although less common, abnormal bleeding can sometimes be a symptom of conditions that require early treatment, including:
- Endometrial hyperplasia (thickened uterine lining)
- Endometrial or cervical cancer
- Blood clotting disorders
- Pregnancy-related complications such as miscarriage or ectopic pregnancy
Symptoms to Watch For
It’s important to understand not only the amount of bleeding but associated symptoms that may indicate the need for prompt evaluation. These include:
- Periods that soak through a pad or tampon every hour for multiple hours
- Large blood clots during menstruation
- Bleeding between periods or after intercourse
- Bleeding after menopause
- Extreme cramping, dizziness, fatigue, or symptoms of anemia
If you experience any of these, don’t ignore them as early evaluation can make a significant difference in outcomes.
How AUB Is Diagnosed
Diagnosis starts with a thorough medical history and physical examination. Your provider may recommend:
- Ultrasound imaging to examine the uterus and ovaries
- Endometrial biopsy to sample the uterine lining
- Hormone level testing
- Hysteroscopy — a minimally invasive look inside the uterus
These tests help pinpoint the cause and guide treatment decisions.
Treatment Options
Treatment for abnormal uterine bleeding is highly individualized and depends on your age, symptoms, goals for fertility, and underlying cause.
Medical Management
- Hormonal therapies such as oral contraceptives or progesterone
- Hormonal IUDs to regulate the endometrial lining
- Non-hormonal medications and NSAIDs for symptom relief
These options can often regulate bleeding without surgery.
Minimally Invasive Procedures
- Endometrial ablation – destroys a thin layer of the uterine lining to reduce or eliminate bleeding
- Hysteroscopic polyp removal or fibroid interventions
- Dilation and curettage (D&C) — a method to clear excessive tissue and control bleeding
Surgical Intervention
For some women, especially those who have completed childbearing or when conservative measures aren’t effective, a hysterectomy (removal of the uterus) may be considered as a definitive solution.
When to Contact Your Provider
If your menstrual bleeding varies significantly from your usual pattern, or if you’re experiencing any of the concerning symptoms listed above, it’s time to schedule an evaluation. Early assessment allows for diagnosis and treatment before complications — such as anemia or fertility challenges — develop.
At Grace, we are dedicated to helping you understand your body, identify what’s normal, and provide the care needed to restore health and peace of mind. If irregular or heavy bleeding is affecting your quality of life, reach out to our team in Fort Worth or Granbury — we’re here to partner with you in your reproductive health journey.
Posted in: Well-Woman Visit, Women's Health