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Abnormal Periods

What is a normal cycle?

The normal length of the menstrual cycle is typically between 24 days and 38 days. A normal menstrual period generally lasts up to 8 days.


When is bleeding abnormal?

Bleeding in any of the following situations is considered abnormal uterine bleeding:

  • Bleeding or spotting between periods

  • Bleeding or spotting after sex

  • Heavy bleeding during your period

  • Menstrual cycles that are longer than 38 days or shorter than 24 days

  • “Irregular” periods in which cycle length varies by more than 7–9 days

  • Bleeding after menopause


At what ages is abnormal bleeding more common? 

Abnormal bleeding can occur at any age. However, at certain times in a woman’s life it is common for periods to be somewhat irregular. Periods may not occur regularly when a girl first starts having them (around age 9–14 years). During perimenopause (beginning in the mid–40s), the number of days between periods may change. It also is normal to skip periods or for bleeding to get lighter or heavier during perimenopause.


What causes abnormal bleeding?

Some of the causes of abnormal bleeding include the following:


How is abnormal bleeding diagnosed?

It may be helpful to keep track of your menstrual cycle before your visit. Note the dates, length, and type (light, medium, heavy, or spotting) of your bleeding on a calendar. You also can use a smartphone app designed to track menstrual cycles. Flo is a great app for this.

You will have a physical exam. You also may have blood tests. These tests check your blood count and hormone levels and rule out some diseases of the blood. You also may have a pregnancy test and tests for sexually transmitted infections (STIs).


What tests may be needed to diagnose abnormal bleeding?

  • Ultrasound exam (or sonogram)—Sound waves are used to take a picture of the pelvic organs.

  • Hysteroscopy—A thin, lighted scope is inserted through the vagina and the opening of the cervix. It allows your ob-gyn or other health care professional to see the inside of the uterus.

  • Endometrial biopsy—A sample of the endometrium is removed and looked at under a microscope.

  • Sonohysterography—Fluid is placed in the uterus through a thin tube while ultrasound images are made of the inside of the uterus.

  • Magnetic resonance imaging (MRI)—An MRI exam uses a strong magnetic field and sound waves to create images of the internal organs.

  • Computed tomography (CT)—Shows internal organs and structures in cross-section.


What medications are used to help control abnormal bleeding?

  •  Hormonal birth control methods—Birth control pills, the patch, the shot, and the vaginal ring contain hormones. These hormones can lighten menstrual flow. 

  • Gonadotropin-releasing hormone (GnRH) agonists or antagonists —Oriahnn and Myfembree can stop the menstrual cycle and reduce the size of fibroids.

  • Tranexamic acid—This medication treats heavy menstrual bleeding. Tranexamic acid or TXA is an antifibrinolytic agent. It works by blocking the breakdown of blood clots, which prevents bleeding.

  • Antibiotics—If you have an infection, you may be given an antibiotic.

  • Mirena IUD

  • NSAIDs --- Like Naproxen, Mefenamic acid, even Ibuprofen can lighten your bleeding and control pain at the same time. 



Seed cycling may relieve some of your symptoms if a hormonal imbalance is present. Seed cycling is not really new but it is newly trendy for the management of abnormal periods. 

What types of surgery are performed to treat abnormal bleeding?

Endometrial ablation with NovaSure destroys the lining of the uterus. It stops or reduces the total amount of bleeding. Pregnancy is not likely after ablation, but it can happen. If it does, the risk of serious complications, including life-threatening bleeding, is greatly increased. If you have this procedure, you will need to use birth control until after menopause.

Uterine artery embolization is a procedure used to treat fibroids. This procedure blocks the blood vessels to the uterus, which in turn stops the blood flow that fibroids need to grow. Another treatment, myomectomy, removes the fibroids but not the uterus.

Hysterectomy, the surgical removal of the uterus, is used to treat some conditions or when other treatments have failed. Hysterectomy also is used to treat endometrial cancer. After the uterus is removed, a woman can no longer get pregnant and will no longer have periods.

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