The menstrual cycles begins with the first day of bleeding and ends with the first day of the next menstrual period. The average cycle is about 28 days but may be longer or shorter. In general, if the cycle lasts longer than 35 days or is shorter than 21 days, it may be abnormal. The complete absence of periods may also be abnormal and should be reported if an absence of bleeding occurs for more than 3 normal cycles. Abnormal uterine bleeding also includes bleeding between periods, bleeding after sex, and bleeding heavier or longer than normal. Periods are often not regular in the first few years after periods begin and again around menopause.
There are many causes of abnormal bleeding. Some of these problems are not serious and can be easily treated while others are more serious. All should be evaluated.
To diagnose abnormal bleeding, facts about your personal history are important. Expect to be asked about your past and present illnesses, medications, birth control, eating habits, weight and level of stress. It is helpful for you to keep specific dates and length of bleeding by marking them on a calendar. In addition to a physical exam, one or more of the following tests or procedures may be recommended: an endometrial biopsy, ultrasound, hysteroscopy, dilation and curettage, and laparoscopy.
Treatment for abnormal bleeding will depend on several factors including your desire for future children, age, the amount of bleeding, and cause. Hormones are often prescribed and may consist of estrogens and progesterones. Surgery may also be recommended, including endometrial ablation, removal of fibioids or polys, and hysterectomy.