Dr. Raja S. Mittapalli, an obstetrician-gynecologist at IU Health North and IU Health Saxony Hospitals, says the most common questions he receives are about abnormal uterine bleeding. And it’s more common than you think! We recently connected with Dr. Mittapalli, and he explained this complex issue that many women go through.
What is considered abnormal uterine bleeding?
Dr. Mittapalli says there are several factors that can indicate abnormal uterine bleeding. Any intermenstrual bleeding, or bleeding between period cycles, is considered abnormal. “The typical menstrual cycle occurs every 28 days and lasts for five days,” he says. “It is considered abnormal uterine bleeding if the cycle occurs less than every 21 days or more than every 35 days.” When it comes to blood loss, Dr. Mittapalli says it’s not so much about the amount of blood lost, but how you are feeling. If you are feeling weak or tired on top of the intermenstrual bleeding, then that is concerning.
What is the typical age range for having this medical issue?
The age range is wide, says Dr. Mittapalli. Abnormal bleeding can affect any woman from the time of their first period through menopause, and Dr. Mittapalli provided the following causes of abnormal uterine bleeding per age group:
Age group 13-18
- Persistent anovulation (No associated egg release in the cycle)
- Birth control use
- Pregnancy
- Pelvic inflammatory disease
- Coagulopathies (blood clotting)
- Tumors
Age group 19-39
- Pregnancy
- Structural lesions like fibroids or polyps
- Anovulatory cycles secondary to Polycystic ovarian syndrome
- Birth control use
- Endometrial precancer
Age group 40+
- Menopause
- Declining ovarian function
- Endometrial precancer, Endometrial cancer
- Endometrial atrophy, Endometrial polyp, or Fibroids
What are other symptoms associated with abnormal uterine bleeding?
Dr. Mittapalli says beyond the infrequent cycle (every 21 days or less) or bleeding between periods, if the pain of the bleeding is affecting your day-to-day life or affecting your sex life, you should seek medical help with your abnormal bleeding. Also, if you are feeling dizzy, lightheaded, and/or weak, talk to your doctor right away.
What is the difference between endometriosis, polycystic ovarian syndrome (PCOS), and fibroids?
- Endometriosis: Can present mostly with pain symptoms. Your periods can be heavy and painful. Sex can be painful, and there might be difficulty getting pregnant.
- Fibroids: Benign fibrous tumors that can be on top of the uterus, can be in the uterine muscle wall, or inside the uterine cavity.
- PCOS: Imbalance in the hormones with anovulatory cycles (when you do not ovulate).
How do I get diagnosed with abnormal uterine bleeding?
Your doctor will take a look at your medical history and see if there are any underlying medical problems. They will complete a physical exam and do blood work to check for any anemia, thyroid, hormonal, or blood clotting issues. Dr. Mittapalli also says imaging needs to be completed to find out if there are any polyps or fibroids, and an endometrial biopsy should be done to check for any uterine precancer or cancer.
To learn more about the treatments for abnormal uterine bleeding and how IU Health can help, visit IU Health’s Abnormal Uterine Bleeding information page.
About Raja S. Mittapalli, MD
Dr. Raja S. Mittapalli is an obstetrician-gynecologist at IU Health North and IU Health Saxony Hospitals. As an OB-GYN, Dr. Mittapalli specializes in the female reproductive system and care for women during pregnancy, childbirth and postpartum.
Named among the “Best Hospitals in America” by U.S. News & World Report for 22 consecutive years, Indiana University Health is dedicated to providing a unified standard of preeminent, patient-centered care. A unique partnership with Indiana University School of Medicine – one of the nation’s leading medical schools – gives our highly skilled physicians access to innovative treatments using the latest research and technology. Learn more at iuhealth.org.
