Advanced Reproductive Medicine & Gynecology of Hawaii, Inc.

John L. Frattarelli, MD

Reproductive Endocrinology & Infertility

LeighAnn C. Frattarelli, MD, MPH

Gynecology & Reproductive Medicine

Menstrual Disorders

What is abnormal uterine bleeding?

The length of the normal menstrual cycle varies from 21 days to 35 days. When bleeding occurs more frequently than every 21 days or cycles last longer than 35 days the cycle is considered abnormal. Any vaginal bleeding that lasts more than 7 days or is excessively heavy is also abnormal. Abnormal bleeding may be a sign of an underlying problem, or it may just be evidence that the body is not completely mature yet (adolescents) or that the body is nearing menopause. The only way to know the cause is to consult a physician.

Anovulation is the most common cause of abnormal vaginal bleeding. Normally an egg comes out of the ovary every month. When the body’s hormones are not just perfect to stimulate the egg to mature and come out of the ovary, abnormal bleeding usually occurs. This anovulation can cause an early menstrual period, a late menstrual period, a light period or a heavy period. Anovulation is usually a sign of something else going on in the body and is very common in adolescents and older women. One anovulatory cycle, therefore one menstrual period that is a little irregular, is not worrisome, but if bleeding is extremely heavy, occurs less than 21 days from the previous cycle, lasts longer than 7 days or no bleeding comes for more than 3 months (amenorrhea), a thorough evaluation is still needed.

Some women have frequent problems with anovulation. Prolonged anovulation can place a woman at risk for pre-cancer and cancer of the uterus. In that situation, hormones may be needed to restore normal menses and/or protect the uterus from cancer.

Amenorrhea occurs when a woman does not get her period by age 16, or when she stops getting her period for at least three months and is not pregnant.

Amenorrhea is not a disease. Instead, it is a symptom of another condition. Possible causes can include moderate or excessive exercising, eating disorders (such as anorexia nervosa), physical or psychological stress, tumors, and hormonal problems. Women with polycystic ovary syndrome (PCOS) may also experience amenorrhea.

It is important to see a physician to determine the cause of amenorrhea. Treatment for amenorrhea depends on the underlying cause. Sometimes lifestyle changes can help if weight, stress, or extreme physical activity is causing the amenorrhea. Other times, medications such as oral contraceptives can help the problem.

Oligomenorrhea refers to infrequent menstrual periods, or having a period only now and then. Like amenorrhea, oligomenorrhea is not a disease itself, but is a symptom of a larger condition. For example, many women with polycystic ovary syndrome (PCOS) have oligomenorrhea. Oligomenorrhea can be normal in an adolescent or a woman nearing menopause.

Uterine fibroids are the most common, non-cancerous tumors in women of childbearing age. Women who have uterine fibroids but show no symptoms may not need any treatment. Some women with fibroids have heavy menstrual periods, and some may bleed in between periods. Medications can often offer relief from many of the symptoms of fibroids, such as pain, and can even slow or stop their growth. There are also several types of surgery that can remove the fibroids. Most women with fibroids do not have problems with fertility and can get pregnant, but some women with fibroids may not be able to get pregnant naturally.

Uterine cancer or pre-cancer (sometimes called hyperplasia) is the most worrisome cause of abnormal vaginal bleeding. Most cancer of the uterus is caught in the very early treatable stages due to worrisome vaginal bleeding. The risk of cancer and pre-cancer increases with age. Cancer is most common after menopause. A simple office procedure called an endometrial biopsy can check to see if cancer or pre-cancer exists in the uterus.