Abnormal Bleeding: Find the Cause, Get the Right Treatment
Heavy, irregular, prolonged or unexpected bleeding is one of the most common reasons women see a gynecologist, and it is usually treatable. We find the cause with a structured evaluation and match treatment to it.
Bleeding that needs evaluation
AUB is bleeding that differs from your normal in volume, duration, regularity or frequency.
- Soaking a pad or tampon every 1–2 hours
- Periods lasting more than 7 days
- Bleeding between periods or after sex
- Cycles shorter than 21 or longer than 35 days
- Passing clots larger than a quarter
- Fatigue or dizziness from blood loss
- Any bleeding after menopause
- Sudden change from your usual pattern
Why it matters: ongoing heavy bleeding can cause iron-deficiency anemia, and bleeding can occasionally signal precancer or cancer of the uterine lining. Postmenopausal bleeding should always be checked.
The PALM–COEIN framework
Gynecologists use this international (FIGO) system to sort causes into structural problems we can see and non-structural problems we test for.
| Structural (PALM) | What it is | Non-structural (COEIN) | What it is |
|---|---|---|---|
| Polyps | Growths in the uterine lining | Coagulopathy | Blood-clotting disorders |
| Adenomyosis | Lining tissue inside the uterine muscle | Ovulatory dysfunction | Irregular or absent ovulation, e.g. PCOS, thyroid |
| Leiomyoma | Fibroids, benign growths in the uterine wall | Endometrial | Disorders of the lining itself |
| Malignancy / hyperplasia | Cancer or precancer of the lining | Iatrogenic / Not classified | Medications, hormones, IUDs, or less-defined causes |
From first visit to a clear answer
-
History and exam
A board-certified gynecologist reviews your bleeding pattern and performs a pelvic exam to confirm the bleeding is from the uterus, not the cervix or vagina.
-
Targeted testing
Blood count, pregnancy and thyroid tests, Pap test if due, pelvic ultrasound, and an endometrial biopsy when indicated.
-
Treatment plan
Options range from hormonal or non-hormonal medication and a hormonal IUD to hysteroscopy, ablation or robotic surgery.
In most cases AUB is benign and very treatable once the cause is known.
Frequently asked questions
Is heavy bleeding just something I have to live with?
No. Heavy periods are common but not normal, and effective treatments exist for nearly every cause.
Will I need surgery?
Most women improve with medication or a hormonal IUD. Procedures are considered when medical treatment fails or a structural cause such as a polyp or fibroid is found.
Should I come in while I'm bleeding?
Yes, you can be seen while bleeding. Call us; if bleeding is very heavy or you feel faint, go to the nearest emergency room.
Bleeding not normal for you?
Schedule an evaluation with Dr. Hema Jonnalagadda, MD in Plymouth Meeting.
