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Abnormal Periods: When Should You Worry?

Summary & Participants

Does your period seem unusual? Is it surprisingly heavy, or unpredictable and infrequent? Abnormal uterine bleeding comes in many forms, and has many different causes, from fibroids and polyps to hormonal problems. Fortunately, in many cases the condition can be cured quickly and easily. Join our experts to learn why AUB happens, and what you can do about it.

Medically Reviewed On: June 25, 2008

Webcast Transcript

If you are on hormone replacement therapy, when the bleeding may be happening on that replacement. All those things are clues to help figure out what is the core of the problem.

MARY WAGNER: What could be some of the causes of abnormal uterine bleeding?

GRACE JANIK, MD: One big category of cards can be hormonal abnormalities. Patients who have cycles very infrequently and have a syndrome called polycystic ovarian disease causing them to not ovulate on a regular basis, and maybe produce a little bit too much male hormone. So excess hair growth, a little bit of obesity. So that's one of the hormonal categories.

Then there's the anatomic grouping where you can have polyps which is a build up of tissues that's the endometrial lining or fibroids which is smooth muscle tumors which extrude into the cavity or a part of the wall of the uterus. Or it can be a cancer or pre-cancer condition. Those are the main groupings that are associated with abnormal bleeding.

LINDA BRADLEY, MD: I think patients -- most of our patients may have subtle things and so we want to -- if, for instance, you have easy nose bleeds, if you cut yourself and within a few minutes you don't stop bleeding -- you want to let your physician know.

If you had your tonsils out as a teenager or after having a baby, hemorrhaged a lot, you may forget about these bleeding problems in the past. Those are very, very subtle clues that can lead a doctor to order a Von Willebrand's assay. These are very expensive tests and certainly not every woman needs it. But if a woman bruises easy, nose bleeds, brushing your teeth, gums bleed very easily, paper cuts that don't stop -- those are the signals in our history taking that would say, "You know maybe this $300 test would be helpful." But I don't want women to think that every woman needs this particular assay. But certainly if you're noticing some changes, we should look for those.

And also, a lot of women are using herbal products now. Some multibillion-dollar business and I think some of the herbs are associated with problems that can lead to bleeding. Lots of women are using aspirin and if you're taking anything over the counter, you want to let your physician know because these other things can also lead to bleeding. It's not always the uterus.

What do they say? You can't see the forest for the trees or we get so focused on just the uterus, but there can be other things systemically that cause the problem.

KEITH ISAACSON, MD: The key is that most of this can be determined by a good history when you first see a patient. So if they have a regular cycle, then it's unlikely that they have hormonal problem. And therefore if it's regular cycle, these are very good candidates and the patient should be offered a diagnostic hysteroscopy in the office.

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