Periods are a part of life for women, but what’s normal and not? When your bleeding is abnormal or unexpected, there are treatment options to improve your quality of life and get back to feeling your best.
Dr. Sarah Arnold, MD, FACOG, NCMP (nationally certified menopause practitioner), discusses abnormal uterine bleeding, what it is, and when women should seek help from a medical professional. Dr. Arnold is a Physician Site Lead for the Women's Health and Wellness at Spectrum Health as well as Physical Site Lead for the Midlife, Menopause and Sexual Health Practice at WHWC, and the Cancer, Menopause and Sexual Health Clinic at Lemmen-Holton Cancer Pavilion
Abnormal uterine bleeding can cause significant stress for women, affecting their quality of life when it comes to work, travel, home life, and overall health. One-third of visits to the gynecologist are for AUB and, as women approach menopause and the postmenopausal years, up to 70 percent of referrals to the GYN can for AUB or PMB.
A normal menstrual cycle can range from 21-35 days apart and lasts on average around five days. In premenopausal or perimenopausal women, normal periods vary, but generally, periods lasting more than seven to eight days, frequent spotting or bleeding between periods, or periods so heavy that women soil clothes or are unable to leave the house to do normal activities are abnormal. Any bleeding for a postmenopausal woman is considered abnormal and should be evaluated.
There are many causes for abnormal bleeding, some more common than others and dependent on the patient’s age. In premenopausal or perimenopausal women, we will commonly see hormone imbalances, uterine polyps, and uterine fibroids as causes for abnormal bleeding AUB and PMB can also be a sign of a serious condition such as endometrial hyperplasia or uterine cancer.
Bleeding that falls out of the normal pattern such as mentioned above should be evaluated. Soaking through pads often, passing large clots, prolonged menses lasting longer than seven days or constant spotting are all abnormal. Any vaginal bleeding after menopause is abnormal and should be evaluated. Evaluation begins with a thorough review of her medical and family history as well as a physical exam. The next steps will often include a pelvic ultrasound, lab work, and, sometimes, a small biopsy of the uterine lining. These results are used to help diagnose the condition causing the abnormal bleeding.
Treatment will depend on the patient’s age, the cause of the bleeding, and her overall desires. We can tailor treatment for each individual. This may include options such as oral medications, hormonal IUDs, Uterine ablation, and sometimes surgical treatments such as hysteroscopy (camera into the uterus to remove polyps or take samples), myomectomy (removal of uterine fibroids), or sometimes hysterectomy (removal of the uterus). In most cases, if surgery is needed, we have minimally invasive options to offer (laparoscopy or robotics or vaginal surgery, small incisions with faster healing time). Many women can be back to normal work and activities 3-4 weeks after a hysterectomy. These therapies help to improve the quality of life while also treating the underlying cause.
If you are having any of these symptoms, please call the WHWC and visit the online Wellness Hub at spectrumhealth.org or call 616.267.8520.
Spectrum Health Women's Health & Wellness Center is located at 4069 Lake Dr. SE, Suite 118.
Medical Moment is sponsored by Spectrum Health.