The Primary Causes of Abnormal Bleeding

Up to one third of women will experience abnormal bleeding during their lifetime. Unfortunately, many women don’t seek help. Many of our patients at Gynecologic Surgery and Menopause Solutions believe that heavy bleeding or irregular periods are just a normal problem they must live with.

But the truth is that abnormal bleeding is often the sign of an underlying gynecologic problem that will only get worse with time and may lead to complications. Here’s how to tell if your periods are normal, coupled with information about the top six causes of abnormal bleeding.

Definition of abnormal bleeding

With so much variation among individual women and their menstrual cycles, many of our patients are confused about what is normal and abnormal when it comes to menstrual bleeding. The best way to figure it out is to compare your menstrual cycles to the norm.

Your menstrual periods should occur every 24-34 days, but on average, they’re 28 days apart. Each period should last four to seven days. You have abnormal menstrual bleeding, or abnormal uterine bleeding, if your periods fall outside the normal range.

There are a few variations to keep in mind. Adolescents who are just starting their periods may have bleeding that’s 21-45 days apart. And in the years before menopause, it’s normal to have irregular periods.

Abnormal periods come in many forms, such as menstrual cycles that are shorter or longer than normal. However, the two most common are prolonged or heavy menstrual bleeding (menorrhagia) and irregular bleeding between periods (metrorrhagia).

Definition of heavy bleeding

Since one type of abnormal bleeding is heavy menstrual periods, you’ll also need to know what defines heavy bleeding. Your periods are abnormally heavy if you have any of the following:

Now that you have some information you can use to assess whether your own periods are normal or not, here are the top causes of abnormal bleeding.

Top six causes of abnormal bleeding

As you might guess, there are many possible causes for abnormal menstrual periods. This list includes the top reasons you may have abnormal bleeding:

Polycystic ovary syndrome (PCOS)

PCOS occurs in women who have high levels of insulin and male hormones or androgens. All women need a small amount of male hormones, but when androgens get too high, their ovaries can’t function properly, and periods become irregular or stop altogether.

If you have PCOS, you have at least two of these key symptoms: abnormal menstrual bleeding (including heavy bleeding), multiple ovarian cysts, and symptoms of excessive androgens, such as overgrowth of hair on your face, acne, and balding.

Endometrial polyps

Endometrial polyps form from an overgrowth of the uterine lining. Polyps can be small or large, and you can have one or many. Their primary symptom is abnormal menstrual bleeding, including irregular bleeding, heavy bleeding, and bleeding after menopause.

Uterine fibroids

These noncancerous growths may grow out into the uterine cavity or stay within the uterine wall. They’re known for causing heavy and prolonged menstrual bleeding, as well as pelvic pain.


Endometriosis develops when small pieces of tissue that normally line the uterus, get out of the uterus and grow on structures such as your ovaries, the outside of the uterus, and Fallopian tubes. Though endometriosis is best known for causing pain, it can also lead to heavy menstrual periods or bleeding between periods.


You develop adenomyosis when the uterine lining grows deep into the muscular uterine wall. This condition causes heavy or prolonged menstrual bleeding.

Pelvic inflammatory disease (PID)

PID is a bacterial infection that’s spread through sexual contact. In addition to pelvic pain and painful intercourse, PID causes bleeding between menstrual cycles.

There are many additional causes for abnormal bleeding, from thyroid disorders to stress, intensive exercise, and eating disorders. Once we determine the cause of your bleeding, we can develop customized treatment to help restore normal periods. 

If you struggle with abnormal bleeding, call Gynecologic Surgery and Menopause Solutions, or schedule an appointment online.

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