Abnormal uterine bleeding means periods that are too heavy, too long, too frequent or irregular, bleeding between periods or after sex, or any bleeding after the menopause. It is one of the most common reasons for seeing a gynaecologist.
Treatment depends entirely on the cause, your age and whether you want future pregnancy. Most causes are benign and respond to medicines or a minor procedure. Bleeding after the menopause, and persistent irregular bleeding after 45, always need the womb lining checked to exclude pre-cancer or cancer.
Symptoms
- Soaking a pad or tampon every 1 to 2 hours, or passing large clots
- Periods lasting more than 7 to 8 days
- Cycles shorter than 24 days or longer than 38 days, or unpredictable timing
- Spotting between periods or after intercourse
- Any bleeding a year or more after the last period
- Tiredness, breathlessness or dizziness from iron deficiency
Causes and risk factors
Gynaecologists group causes with the acronym PALM-COEIN. Structural causes are polyps, adenomyosis, leiomyomas (fibroids) and malignancy or hyperplasia of the lining. Non-structural causes are clotting disorders such as von Willebrand disease, ovulation problems as in polycystic ovary syndrome, thyroid disease, the years around puberty and before menopause, problems of the lining itself, effects of medicines such as anticoagulants, hormonal contraception or a copper coil, and rarer conditions. Pregnancy complications must always be excluded first in anyone who could be pregnant.
How it is diagnosed
- History and examination: Pattern of bleeding, medicines, family history of bleeding problems, speculum examination and cervical screening.
- Blood tests: Full blood count and ferritin, pregnancy test, thyroid function and, where indicated, clotting studies and hormone levels.
- Transvaginal ultrasound: Measures the lining and shows fibroids, polyps and adenomyosis. Saline infusion improves detection of polyps.
- Endometrial biopsy: A thin suction sampler in the clinic. Advised over 45, after menopause, or with risk factors such as obesity and PCOS.
- Hysteroscopy: A fine camera inspects the cavity and can remove polyps or small fibroids in the same sitting.
Treatment options
- Tranexamic acid and anti-inflammatory tablets: Taken only during the period; reduce flow by up to half without hormones.
- Hormonal intrauterine system: A levonorgestrel coil reduces bleeding by around 90 percent in a year and is first choice for many.
- Combined pill or progestogens: Regulate cycles and lighten bleeding, particularly with ovulation problems.
- Iron replacement: Tablets or an intravenous infusion to correct anaemia.
- Hysteroscopic polypectomy or myomectomy: Removes polyps and fibroids bulging into the cavity as a day case.
- Endometrial ablation: Destroys the lining when the family is complete. Pregnancy afterwards is dangerous, so contraception is needed.
- Fibroid procedures: Myomectomy or uterine artery embolisation for larger fibroids.
- Hysterectomy: Definitive treatment when other options fail or are unsuitable.
When it is urgent
Seek emergency care near you, not travel, if you soak through pads hourly for several hours, feel faint, breathless or have chest pain, have heavy bleeding with a positive pregnancy test or severe one-sided pain, or have fever with pelvic pain. Any postmenopausal bleeding should be assessed within two weeks.
Travelling to Türkiye for treatment
Acute heavy bleeding and anaemia should be stabilised at home. A visit is sensible for a planned procedure once the cause is known, for example hysteroscopic removal of a polyp or fibroid, or for a structured second opinion before hysterectomy. Diagnostic hysteroscopy with biopsy needs about 3 to 5 days including the pathology result. Bring ultrasound reports and blood results. Coil checks and hormone adjustment belong with your own doctor.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
الأسئلة المتكررة
How do I know my periods are too heavy?
If they interfere with daily life, cause flooding or clots, or have left you iron deficient, they are heavy enough to treat.
Do I need a hysterectomy?
Usually not. Most women are managed with medicines, a hormonal coil or a hysteroscopic procedure.
Is a D and C still used?
Blind curettage has largely been replaced by hysteroscopy, which lets the surgeon see and remove the cause.
Could it be cancer?
Uncommon before 45, but the risk rises with age, obesity and after menopause, which is why the lining is sampled in those groups.