Guide to Abnormal Uterine Bleeding (AUB): Causes, Symptoms & Treatment
Discover everything about abnormal uterine bleeding (AUB)—its common causes, symptoms, diagnosis, and effective treatment options.
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Last updated on 12th Sep, 2025
Introduction
Are your periods unpredictable, excessively heavy, or just plain confusing? You're not alone. Abnormal uterine bleeding (AUB) is one of the most common reasons women see a gynaecologist, affecting up to one-third of us in our lifetimes. But what exactly qualifies as "abnormal"? It's more than just a rough cycle; it's a pattern that disrupts your physical and emotional well-being. This comprehensive guide will help you decode your body's signals. We'll break down the potential causes—from fibroids to hormonal shifts—explain the diagnostic process, and explore the wide range of treatment options available. Understanding abnormal uterine bleeding is the first powerful step toward taking control of your health and finding lasting relief.
Is It Normal? Recognising the Signs and Symptoms of AUB
A "normal" period is different for everyone, but medicine has clear guidelines on what falls outside typical ranges. Abnormal uterine bleeding isn't a single thing; it's a spectrum of changes in your menstrual cycle's frequency, regularity, duration, and volume.
Changes in Your Bleeding Pattern
Heavy Menstrual Bleeding (Menorrhagia): Soaking through a pad or tampon every 1-2 hours for several consecutive hours, needing to double up on protection, passing large blood clots, or bleeding that lasts more than 7 days.
- Bleeding Between Periods (Metrorrhagia): Any spotting or bleeding that occurs after your period ends and before your next one begins.
- Irregular Periods: Cycles that are shorter than 21 days (polymenorrhea) or longer than 35 days (oligomenorrhea).
- Postmenopausal Bleeding: Any bleeding that occurs after you have reached menopause (12 consecutive months without a period).
Consult a Gynaecologist for the best advice
Concerning Symptoms That Need a Doctor's Attention
While some variation is normal, certain symptoms alongside AUB are red flags. Seek medical advice if you experience dizziness, lightheadedness, pale skin, or fatigue (signs of anemia), pelvic pain or pressure, or if your bleeding is so heavy it prevents you from living your daily life.
Why Is This Happening? The PALM-COEIN Causes of AUB
To standardise diagnosis, experts use the PALM-COEIN system, which categorises causes into structural (things you can see or image) and non-structural (functional or biochemical).
Structural Causes (The PALM Group)
Polyps and Fibroids: Common Benign Growths
Uterine polyps (small growths on the inner wall) and fibroids (non-cancerous tumors in the muscle wall) are extremely common. They can distort the uterine cavity, leading to heavy or irregular prolonged menstrual bleeding. While often benign, their location and size dictate the symptoms.
Adenomyosis: When Tissue Grows in the Uterine Muscle
This condition occurs when the tissue that normally lines the uterus (endometrium) grows into the muscular wall. This tissue still bleeds during your cycle, causing an enlarged, tender uterus and often severely painful, heavy periods.
Malignancy and Hyperplasia: Ruling Out Cancer
This is the cause women often fear most, though it's less common. Endometrial hyperplasia (a thickened uterine lining) can be a precursor, and endometrial cancer itself can cause bleeding, especially after menopause. It's crucial to rule this out, which is why doctors may recommend a biopsy.
- Non-Structural Causes (The COEIN Group)
- Coagulopathies: Bleeding Disorders
Conditions like Von Willebrand disease mean your blood doesn't clot properly. This can manifest as heavy menstrual bleeding causes that often start from a woman's very first period.
Ovulatory Dysfunction: Hormonal Imbalance
If you don't ovulate regularly (common in PCOS, thyroid disorders, perimenopause, or extreme stress), your body doesn't produce progesterone. This leads to an estrogen-dominated state where the uterine lining builds and builds without being shed, resulting in unpredictable, often heavy bleeding.
Endometrial Issues: When the Lining Itself Malfunctions
Sometimes, the problem is local to the uterine lining, which may have issues with regulating bleeding and healing on a biochemical level, even if everything else seems normal.
Iatrogenic Causes: Medication and Device-Related
This category includes bleeding caused by medical treatments, such as blood thinners, certain antidepressants, or the presence of a copper IUD. Hormonal IUDs, on the other hand, are often used as a treatment for AUB.
Getting Answers: How Doctors Diagnose Abnormal Uterine Bleeding
Finding the root cause is a detective game. If your condition does not improve after a cycle or two, consulting a doctor is key. You can consult a doctor online with Apollo 24|7 for an initial consultation to discuss your symptoms and history.
The Initial Consultation: Your History and Physical Exam
Your doctor will ask detailed questions about your cycle, medical history, medications, and symptoms. A physical exam, including a pelvic exam, helps assess the size and shape of your uterus and rule out other issues.
Key Diagnostic Tests and What They Show
Blood Tests and Lab Work
A Complete Blood Count (CBC) checks for anemia from blood loss. Thyroid function tests, prolactin, and hormone level checks can identify ovulatory dysfunction. Apollo 24|7 offers convenient home collection for tests like these, making the process easier.
Imaging: Ultrasounds and Sonohysterograms
A transvaginal ultrasound is usually the first imaging step to look for fibroids, polyps, or adenomyosis. A sonohysterogram involves injecting saline into the uterus to provide a clearer picture of the uterine cavity.
Endometrial Biopsy: Checking the Lining
This in-office procedure takes a small sample of the uterine lining to check for cancer, hyperplasia, or other abnormalities. It's a crucial tool, especially for women over 45 or those with risk factors.
Finding Relief: Treatment Options for AUB
Treatment is highly personalised and depends entirely on the cause, your severity of symptoms, and whether you wish to have children in the future.
Medications: Regulating Hormones and Reducing Bleeding
Non-Hormonal: NSAIDs (like ibuprofen) can reduce blood loss and cramping. Tranexamic acid is a prescription medication that helps blood clot within the uterine vessels.
- Hormonal: Birth control pills, patches, or rings regulate cycles and reduce lining buildup. Progesterone therapy can counteract estrogen dominance. The hormonal IUD (Mirena) is often a first-line treatment as it thins the endometrial lining, dramatically reducing bleeding.
Procedures and Surgical Interventions
Minimally Invasive: A hysteroscopy can be used to remove polyps or fibroids. Endometrial ablation destroys the uterine lining to reduce or stop bleeding (not for those who want future pregnancies).
Surgical: A hysterectomy (removal of the uterus) is a permanent, definitive solution for severe cases that don't respond to other treatments. It's a major surgery and considered a last resort.
Conclusion
Understanding abnormal uterine bleeding empowers you to advocate for your health. It's a complex issue with a wide range of causes, from the common, like fibroids and hormonal fluctuations, to the more serious. The key takeaway is that persistent, disruptive bleeding is not something you should simply endure. Modern medicine offers a clear diagnostic pathway and a robust toolkit of treatments to manage symptoms, address the root cause, and significantly improve your quality of life. By tracking your symptoms and having an informed conversation with your healthcare provider, you can find a solution that works for your body and your life. If you recognise these signs in yourself, take that first step and seek professional guidance. If symptoms persist beyond two weeks, consult a doctor online with Apollo 24|7 for further evaluation and a personalised path to relief.
Consult a Gynaecologist for the best advice
Consult a Gynaecologist for the best advice
Dr. Asha Rani Singh
Obstetrician and Gynaecologist
24 Years • MBBS DGO
Delhi
Dr Asha Rani Singh Clinic, Delhi
Dr. Ramya G S
Obstetrician and Gynaecologist
11 Years • MBBS, DGO - Obstetrics & Gynaecology, DNB - Obstetrics & Gynaecology
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Dr. Mona Yadav
Obstetrician and Gynaecologist
19 Years • MBBS, MD (Obstetrics & Gynaecology)
Dombivli
Nulife multispeciality, Dombivli
Dr. Sridevi Matta
Obstetrician and Gynaecologist
28 Years • MS ( OBG ), DGO, DNB Obstetrics & Gynaecology
Chinagadila
Apollo Hospitals Health City Unit, Chinagadila
(175+ Patients)
Dr. Soumya P
Obstetrician and Gynaecologist
6 Years • MBBS,MS (OBST & GYNAE)
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Consult a Gynaecologist for the best advice
Dr. Asha Rani Singh
Obstetrician and Gynaecologist
24 Years • MBBS DGO
Delhi
Dr Asha Rani Singh Clinic, Delhi
Dr. Ramya G S
Obstetrician and Gynaecologist
11 Years • MBBS, DGO - Obstetrics & Gynaecology, DNB - Obstetrics & Gynaecology
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Dr. Mona Yadav
Obstetrician and Gynaecologist
19 Years • MBBS, MD (Obstetrics & Gynaecology)
Dombivli
Nulife multispeciality, Dombivli
Dr. Sridevi Matta
Obstetrician and Gynaecologist
28 Years • MS ( OBG ), DGO, DNB Obstetrics & Gynaecology
Chinagadila
Apollo Hospitals Health City Unit, Chinagadila
(175+ Patients)
Dr. Soumya P
Obstetrician and Gynaecologist
6 Years • MBBS,MS (OBST & GYNAE)
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
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Frequently Asked Questions
Can stress really cause abnormal uterine bleeding?
Yes, absolutely. High levels of physical or emotional stress can disrupt the delicate hormonal balance needed for ovulation. This is a form of ovulatory dysfunction, leading to missed, late, or unusually heavy periods.
Should I be worried about cancer if I have AUB?
While it's a concern many women have, most cases of AUB are not cancer. However, because endometrial cancer presents with bleeding, it is a condition doctors must rule out, especially in women over 45 or those with risk factors like obesity. This is why a prompt evaluation is important.
What is the best treatment for heavy menstrual bleeding?
There is no single 'best' treatment; it depends on the cause and your goals. For many, a hormonal IUD is highly effective. For others, tranexamic acid or birth control pills work well. If medications fail, procedures like endometrial ablation can be considered. Your doctor will help you choose the right option.
Can AUB affect my fertility?
It can, but not always. AUB is often a symptom of an underlying condition like PCOS or fibroids, which can impact fertility. Successfully treating the root cause of the bleeding can often improve your chances of conceiving.
How long should I wait before seeing a doctor for abnormal bleeding?
Don't wait for a specific timeline if you're concerned. See a doctor if you have even one episode of bleeding after menopause, if your bleeding is so heavy it soaks through protection in an hour, or if irregular bleeding persists for 2-3 cycles.