Knowing What's Normal

Normal menstrual flow for women lasts approximately five days and occurs every 21 to 35 days. What’s not normal: bleeding between periods, bleeding for too long, having an extremely heavy flow or bleeding after menopause. Our gynecologists explain.

What causes abnormal uterine bleeding (AUB)?

Dr. Bennis: Major causes of AUB are structural abnormalities in the uterus like fibroids (benign overgrowths of uterus muscle) and polyps (benign overgrowths of the uterus lining or cervix). For women who have polycystic ovarian syndrome, their periods may not come at regular intervals or at all because their hormones are out of balance. If women are approaching or are in menopause, their hormonal changes can cause the uterus lining to thicken which can cause bleeding. We also want to check for certain types of cancer, including endometrial, uterine, cervical and vaginal.

How is AUB diagnosed?

Dr. Haarsma: First we start with a clinic visit where we cover a woman’s medical history, symptoms and perform a medical exam. For women who haven’t entered menopause, we make sure they’re not pregnant. We’ll also run blood tests to check for anemia and check thyroid function and hormone levels. We may also perform an ultrasound or endometrial biopsy. If those come back inconclusive, we’ll perform a hysteroscopy with dilation and curettage (D & C) at Brookings Hospital. This is a same-day procedure that allows us to examine a woman’s uterus with a camera to help determine the cause of AUB. If we find abnormalities, like fibroids or polyps, we can remove those right away. We’ll also scrape the uterus lining to obtain tissue for further testing and diagnosis.

How is AUB treated?

Dr. Sholes: Treatment depends on the root cause. We often try to control the condition first through hormone therapy or birth control. If that doesn’t work, we start to look at surgical options. If the cause is fibroids or polyps, we can perform a surgical procedure called a myomectomy to remove those while still keeping a woman’s ability to have children intact. For women who are done having children but haven’t yet gone through menopause, we can perform uterine ablation, a procedure at Brookings Hospital by which we destroy the lining of the uterus through heat or radio-controlled frequency. Removing the uterus by hysterectomy may be done when other treatment methods fall short.

Is abnormal uterine bleeding impacting your quality of life? Visit brookingshealth.org/AUB to learn more or make an appointment with a gynecologist from Avera Medical Group Specialty Care by calling (605) 696-2700.