What is the exact definition of this term?

AUB is bleeding from the uterus that is heavier, longer, more frequent, less frequent, or irregular compared with a person’s usual period. It includes heavy menstrual bleeding, prolonged bleeding, spotting between periods, and bleeding after sex. In people who are not pregnant, doctors often group causes using the PALM-COEIN system:

PALM (Structural causes): Polyp, Adenomyosis, Leiomyoma (fibroids), Malignancy/Hyperplasia.

COEIN (Non-structural causes): Coagulopathy (bleeding disorders), Ovulatory dysfunction, Endometrial (lining problems), Iatrogenic (medications/devices), Not yet classified.

Common symptoms

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Periods lasting >7 days, needing to change pads/tampons every 1–2 hours, passing clots >2.5 cm, or bleeding between periods.

Fatigue, dizziness, shortness of breath (possible iron-deficiency anemia).

Causes & contributors

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Age-related: anovulatory cycles in teens and perimenopause.

Hormonal: thyroid disorders, hyperprolactinemia, PCOS.

Medications/devices: anticoagulants, hormonal contraception changes, copper IUD (may increase flow initially).

Systemic: bleeding disorders (e.g., von Willebrand disease), liver/kidney disease.

Pregnancy-related bleeding is assessed separately.

How it’s diagnosed

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Pregnancy test if there is any chance of pregnancy.

History (cycle pattern, bleeding severity, medications, family bleeding history) and pelvic exam.

Labs: blood count and ferritin (anemia), thyroid tests, prolactin if cycles are infrequent.

Imaging: pelvic ultrasound (often transvaginal) to look for fibroids/polyps; saline-infusion sonohysterography can better outline the uterine cavity.

Endometrial sampling (biopsy): recommended for age ≥45 or younger with risk factors (e.g., obesity, chronic anovulation, persistent bleeding, or failed medical therapy). If pregnancy is desired, ovulation induction may be offered depending on cause.

Treatment options (tailored to goals such as symptom control, preserving fertility, and underlying cause):

First - line medical:

Levonorgestrel intrauterine system (LNG-IUS) – often the most effective non-surgical option for heavy bleeding.

Hormonal options: combined oral contraceptives, progestin-only pills or injections, cyclic or continuous progestins.

Non-hormonal: Tranexamic acid during menses; NSAIDs (e.g., ibuprofen, mefenamic acid) to reduce flow and cramps.

Acute heavy bleeding (soaking ≥1 pad/hour, large clots, or symptomatic anemia): high-dose estrogen-progestin regimens, high-dose progestin, or IV tranexamic acid under clinician supervision; treat anemia (iron).

Targeted procedures (for structural causes):

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Polyps: hysteroscopic polypectomy.

Fibroids: myomectomy, uterine artery embolization, or focused ultrasound; hysterectomy if childbearing complete and other treatments fail.

Endometrial ablation for selected patients who do NOT desire future pregnancy.

Address contributing conditions (thyroid disease, coagulation disorders, medication side effects).

When to seek urgent care

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Soaking through pad/tampon every hour for >2–3 hours

Passing egg-sized clots,

Fainting,

Chest pain, or shortness of breath.

What to expect at our clinic

Symptom review, exam, labs for anemia/thyroid, personalized plan (medical first whenever appropriate), and discussion of fertility goals. If needed, we offer imaging and outpatient hysteroscopy for diagnosis and treatment.

Deep dive

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How we quantify flow: needing to change protection more often than every 2 hours, passing large clots, nighttime leakage, or anemia signs signal heavy bleeding. We may use a pictorial bleeding assessment chart to track severity across cycles.

Bleeding disorders: up to 1 in 5 adolescents with very heavy menses have an underlying coagulation issue (e.g., von Willebrand disease). We ask about nosebleeds, easy bruising, heavy bleeding with dental work or surgery, and family history.

Testing nuances: saline-infusion sonography highlights small intracavitary lesions; hysteroscopy allows “see and treat.” Endometrial biopsy can be done in the office and typically causes brief cramping; results usually return within a week.

Procedure choices: endometrial ablation is for people finished with childbearing; pregnancy after ablation is unsafe and uncommon—reliable contraception is still advised. Myomectomy preserves the uterus; hysterectomy is definitive and removes the chance of uterine cancer but ends fertility.

Medication specifics:

   Tranexamic acid is taken on heavy days only; it does not affect hormones or fertility.

   NSAIDs reduce prostaglandins and help both flow and pain; take with food and avoid if you have ulcers/kidney disease.

   LNG-IUS often reduces bleeding by \~70–90% after several months; initial spotting/irregularity is common.

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