Normal menstrual periods occur no more frequently than very 21
days, last no longer than 7 days and require changing a pad no more
frequently than every 4 hours or a tampon every 3 hours. Any vaginal
bleeding which is more than this is considered to be abnormal and
requires further evaluation and possible treatment.

Abnormal uterine bleeding (AUB) may be due to structural
abnormalities of the uterus. Some of the more common structural
causes of abnormal uterine bleeding include benign (non-cancerous)
lesions of the uterus such as polyps, fibroids (myomas), and
adenomyosis . Other causes include bleeding associated
with early pregnancy, including miscarriage and ectopic pregnancy,
and bleeding disorders which affect the ability of the blood to clot
normally. Lesions of the cervix or vagina (benign and cancerous),
chronic infections of the endometrial lining
(endometritis), scar tissue ( adhesions) in the endometrium, and the
use of an intrauterine device (IUD) may also be associated with
abnormal uterine bleeding. Additional causes of abnormal bleeding
include medications which can affect the normal release of estrogen
and progesterone, chronic medical problems such as diabetes
mellitus or disorders of the liver, kidney, thyroid gland, or adrenal
glands, or other medical problems which can affect the production
and metabolism of estrogen and progesterone. Emotional or physical
stress as well as significant changes in body weight may disrupt the
pituitary’s release of FSH and LH and prevent ovulation.

Dysfunctional uterine bleeding
(DUB) is the occurrence of uterine
bleeding unrelated to structural abnormalities of the uterus or the
endometrial lining. It is a diagnosis of exclusion made after
structural causes of bleeding and chronic medical diseases
have been ruled out. Other causes of abnormal bleeding must also
be disproved, including pregnancy complications and medications
which influence hormonal action or affect clotting. DUB occurs most
commonly in the first five years after a woman starts menstruating
and as she approaches menopausee. The main cause of
DUB is anovulation, the absence of ovulation and the orderly
secretion of estrogen and progesterone. DUB may alert the woman
and her physician to the fact that she is no longer ovulating normally.

Evaluation of abnormal bleeding may require lab tests, ultrasounds
or biopsies to determine the cause of the bleeding. Once the cause
of the bleeding has been determined, you and your doctor will decide
the treatment most appropriate for you.