What’s Considered Dysfunctional Uterine Bleeding?
Medically reviewed by Cordelia Nwankwo, MD
Dysfunctional uterine bleeding is when you experience vaginal bleeding that is different from your typical menstrual cycle. Since the menstrual cycle is governed by sex hormones, dysfunctional uterine bleeding can be the result of hormonal imbalances or irregularities. However, many other causes exist, such as medications, stress, and certain diseases.
In this article, learn more about dysfunctional uterine bleeding, including how it can present in puberty, pregnancy, and menopause.
Photo composite by Tara Anand for Verywell Health; Getty Images
Meaning of Dysfunctional Uterine Bleeding
Dysfunctional uterine bleeding—sometimes called abnormal uterine bleeding—refers to vaginal bleeding that is different from your normal menstrual cycle.
These differences can be related to:
How much you bleed (i.e., heavy or light bleeding)
When you bleed (i.e., in between periods, after sex, or during a delayed or early period)
How long you bleed (i.e., long or short periods)
How the blood appears (i.e., color, texture, clots)
Periods
A typical menstrual period lasts up to seven days, with the entire cycle (from the first day of your period to the first day of your next period) lasting 21 to 35 days. Deviations from this could indicate dysfunctional uterine bleeding.
The following are signs of dysfunctional uterine bleeding related to your period:
Excessive bleeding: Heavy bleeding (called menorrhagia) is considered to be bleeding that lasts longer than seven days or soaks through one or more pads or tampons every hour.
No bleeding or short cycles: Missing your period for three to six months (called amenorrhea) is a sign of dysfunctional uterine bleeding. Cycles that last less than 21 days or more than 35 days are also considered dysfunctional uterine bleeding.
Texture: Period blood and vaginal discharge come in many colors and textures, most of which are expected. However, look out for excessive clots or changes in thickness. In terms of color, green and gray discharge could be a sign of infection.
Accompanying symptoms: In addition to bleeding changes, accompanying symptoms such as severe painful periods (called dysmenorrhea) are not normal and could be a sign of an underlying condition.
Bleeding between cycles: Vaginal bleeding that happens while you're not on your period—called metrorrhagia—is a possible sign of something abnormal. Additionally, bleeding or spotting after sex is considered abnormal.
Irregularity: Generally, you have a menstrual cycle pattern that's "normal" to you regarding cycle lengths and flow. If you have irregular periods, meaning your cycle length changes by more than seven to nine days, this is considered dysfunctional uterine bleeding.
Pregnancy
Most people think that your period stops while you are pregnant. While this is generally true, some people may experience vaginal bleeding during pregnancy.
Most of the time, this is not a sign of a problem. However, in some cases, bleeding can indicate miscarriage or ectopic pregnancy. Be aware of heavy bleeding or bleeding near the end of pregnancy, as these can indicate a serious issue.
If you experience any bleeding during pregnancy, err on the side of caution and call your obstetrician-gynecologist (OB-GYN) for guidance on the next steps.
Menopause
Dysfunctional uterine bleeding is a sign of perimenopause, which happens in the years leading up to menopause. Changes in your period frequency, how much and how many days you bleed, and blood thickness—among other symptoms—occur as a result of your ovaries producing less estrogen.
According to the American College of Obstetricians and Gynecologists (ACOG), any bleeding after menopause is considered abnormal.
Conditions That Cause Dysfunctional Uterine Bleeding
Many factors can cause dysfunctional uterine bleeding, such as structural changes to the uterus or hormonal shifts.
Some common causes of dysfunctional uterine bleeding include the following:
Bleeding disorders
Hormonal changes from perimenopause
Medication
Miscarriage or ectopic pregnancy
Ovulation dysfunction from conditions like polycystic ovary syndrome (PCOS)
The symptoms of your bleeding changes can point to the underlying cause.
For example, going three months or longer without a period could be a sign of PCOS or perimenopause, depending on your age and other related symptoms. It could also be due to hormonal birth control methods like the intrauterine device (IUD).
Heavy bleeding accompanied by pain could indicate adenomyosis, endometriosis, or fibroids.
Factors like age, fertility, additional symptoms, and medications can all clue you into the cause, though there can be multiple causes behind dysfunctional uterine bleeding.
Underdiagnosis
If you experience excessive bleeding or other symptoms of dysfunctional uterine bleeding, seek prompt medical intervention. Sometimes, the cause is harmless; other times, it's a sign of a serious underlying condition.
There is significant underdiagnosis of conditions relating to female reproductive organs, including cervical or endometrial cancer, menopause, PCOS, endometriosis, adenomyosis, and more. The sooner you seek help, the sooner you can get an accurate diagnosis.
As a Medication Side Effect
Your medications can impact uterine bleeding, so it's helpful to understand these possible side effects.
Hormonal birth control, like a continuous-cycle pill or hormonal IUD, are common culprits for causing vaginal bleeding changes. These changes often manifest as lighter and less frequent periods or bleeding mid-cycle. According to one study, 18.2% of people using the levonorgestrel IUD had no period for at least one 90-day interval in their first year of use.
On the other hand, taking blood thinners or aspirin can contribute to heavier-than-normal menstrual bleeding. About 70% of menstruating individuals who take blood thinners experience heavy menstrual bleeding. The non-hormonal copper IUD can also contribute to heavy menstrual bleeding.
How to Handle Sudden Bleeding
It can be frustrating, annoying, and potentially embarrassing to deal with sudden menstrual bleeding, particularly if you're unprepared. While inconvenient, it happens to many people.
To cope with sudden bleeding, be prepared with menstruation supplies. Stock your purse with tampons, your office desk with pads, or stash period underwear in your car.
Having a spare pair of underwear or trousers on hand is also useful—you can also tie a shirt or sweater around your waist in a pinch.
If you don't have supplies handy, many public restrooms sell pads and tampons for a small fee—or you could ask another menstruating individual.
If your sudden bleeding is heavy, contains large clots, or you feel dizzy or in extreme pain, contact a medical provider for help.
Treatments to Stop Dysfunctional Uterine Bleeding
In some cases, dysfunctional uterine bleeding does not go away on its own and requires treatment.
The treatment depends on what the cause of your bleeding is, as well as what type of dysfunction you're having. Hormonal birth control is frequently recommended to regulate frequent or heavy periods.
Some medical treatments for heavy menstrual bleeding include:
Non-Medical Alternatives
There are various home remedies for dysfunctional uterine bleeding, but keep in mind there is not as much evidence to support these methods.
Many people with PCOS, a syndrome that is often accompanied by infrequent periods, choose to treat themselves with diet and lifestyle changes. PCOS supplements include:
Anemia Risk With Dysfunctional Uterine Bleeding
Dysfunctional uterine bleeding that lasts longer than seven days or is particularly heavy can lead to anemia.
Iron deficiency anemia is when the body does not have enough red blood cells, resulting in intense fatigue, coldness, pale skin, depression, fainting, and more. One study of 150 people with heavy menstrual bleeding found that 51% had low iron, and 40% qualified as anemic.
Hospitalization for Severe Bleeding
In the case of severe uterine bleeding, you may require hospitalization. After stabilizing you, your medical provider will administer medication, such as multiple doses of hormonal contraception or tranexamic acid, to slow the bleeding. They will also look for the cause of the bleeding. Surgery may be required in rare cases.
Steps to Getting Dysfunctional Bleeding Diagnosed
If you are having what you believe is dysfunctional uterine bleeding, it's important to get a proper diagnosis. Treatment differs based on the cause of the bleeding so this is an essential first step.
Tracking your menstrual cycle can be a helpful tool for determining irregularities. There are many apps for this, but you could also use a calendar or notebook.
Make an appointment with a gynecologist to discuss your concerns, and be sure to mention any other symptoms you're experiencing as well.
Summary
Bleeding is considered dysfunctional if it occurs outside the normal menstrual cycle, is unusually heavy or light, or lasts shorter or longer than usual. There are many possible causes of dysfunctional uterine bleeding, ranging from polyps to medication to health conditions like endometriosis, adenomyosis, PCOS, cancer, and more.
Read the original article on Verywell Health.
