Many women experience abnormal uterine bleeding, and without realizing what it is, delay a visit to their doctor. Instead of treatment, they make changes to their lifestyle. Women shouldn’t do that, said Dr. Lane Williams, a board-certified obstetrician and gynecologist at Jackson Regional Women’s Center. “If it gets to the point where it alters your life, by altering your daily activities or your wardrobe, you need to be evaluated.”

The average menstrual cycle is 21-35 days with bleeding lasting an average of five to seven days. Anything outside of that - or very heavy bleeding during menstruation - is abnormal.

Abnormal uterine bleeding can have several causes: hormonal abnormalities, uterine masses such as fibroids or polyps, a coagulation defect that prevents blood from clotting properly, overgrowth of normal cells, or cancerous cells.

Acute cases of abnormal bleeding can be an emergency - when patients arrive at the hospital with heavy bleeding and dizziness. Doctors will determine whether they need intravenous fluids or a blood transfusion, said Dr. Williams. “You want to make sure they’re stable.”

Chronic cases are more common. Women shouldn’t be concerned if they have infrequent or isolated cases of abnormal bleeding. However, they should see they’re doctor if they’ve noticed a pattern.

“If you have abnormal bleeding that persists at least six months, you would consider it a chronic issue,” Dr. Williams said.

Physicians will evaluate women with chronic abnormal bleeding to find the cause through a process of elimination, he said.

Knowledge of a patient’s history could show evidence of a coagulation defect - a previous nosebleed that wouldn’t stop, for example. A physical exam will determine if a patient has any cervical or vaginal abnormalities. Doctors will also test for pregnancy and perform a blood count to check for anemia.

Part of the initial evaluation is to perform a sonogram or a sonohysterogram, which is an infusion of fluid into the uterus during a sonogram to further evaluate the uterine lining.

An evaluation of the thyroid will check for hypothyroidism or hyperthyroidism - hormone production issues that can cause abnormal bleeding. Doctors will evaluate the lining of the womb in patients 45 and older to check for abnormal cells, such as overgrowth of normal cells or cancer.

Depending on the cause, there are several options for treatment. Doctors can manage hormone levels through prescription medication or an intrauterine device that delivers hormones. They can also prescribe Lysteda, which does not contain hormones, but does reduce bleeding during a woman’s period.

Surgical options include a dilatation and curettage to lightly scrape the uterine lining to remove uterine tissue. A hysteroscopy can also be performed where doctors use a thin, lighted tube to examine the uterus. Any growths that are found can be removed during the procedure.

Other options include an endometrial ablation to destroy the lining, which heals by scarring and helps prevent future bleeding. They can also perform a uterine artery embolization, which is a minimally invasive procedure to restrict blood flow to the uterus.

If conservative or minimally invasive procedures are not effective, a hysterectomy is a last option. If cancer cells are detected, patients may be referred to a gynecology cancer specialist for treatment.

“The earlier we can evaluate abnormal bleeding, the quicker the woman can return to a better quality of life,” Dr. Williams said.

Featured Doctor

Lane Williams, M.D. Obstetrics and Gynecology

Dr. Williams is a graduate of the University of Illinois College of Medicine. He completed his internship and residency at Brookdale Hospital in Brooklyn, New York. Dr. Williams is a fellow of the American College of Obstetricians and Gynecologists. He and his family moved to Jackson from Sycamore, Ill., where he had practiced for five years. Before that, he practiced obstetrics and gynecology for six years in Clinton, Iowa.