Menstrual irregularities or abnormal uterine bleeding
Your doctor will ask about your period pattern—how often you bleed, how long it lasts and how heavy it is—and about other symptoms like pain or pregnancy. They may do a pelvic exam and Pap/HPV test. Blood tests can check for pregnancy, anemia and infections (complete blood count), blood clotting problems, liver and thyroid function, blood sugar and A1C, and hormone levels such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and androgen levels. A transvaginal ultrasound or saline sonogram looks inside your uterus for fibroids or polyps, and sometimes a tiny biopsy of the uterine lining is done to rule out cancer.
Treatment depends on the cause and severity of bleeding. Options include high‑dose estrogen (often given as combined birth control pills) or other hormone therapy to quickly stop heavy bleeding; progestin pills or injections to thin the uterine lining; and a hormone‑releasing intrauterine device (IUD) that steadily reduces bleeding period. Non‑steroidal anti‑inflammatory drugs taken just before your period can lighten flow, and tranexamic acid is a medicine taken at the start of your period to help clotting and decrease blood loss. Iron supplements are used if you have anemia, and medications to treat underlying conditions such as thyroid disease or polycystic ovary syndrome may be prescribed. Surgery (removing polyps or fibroids, endometrial ablation or hysterectomy) is reserved for bleeding that does not improve with medication.
• Pregnancy test – rules out pregnancy as a cause of bleeding
• Complete blood count (CBC) – measures your blood cells to detect anemia or infection
• Coagulation tests and liver function tests – check that your blood clots normally and your liver is healthy
• Fasting blood glucose and hemoglobin A1C – evaluate blood sugar and insulin resistance
• Hormone tests – check follicle‑stimulating hormone (FSH), luteinizing hormone (LH), prolactin, androgen and progesterone levels to look for hormonal causes like PCOS
• Thyroid function tests – measure thyroid‑stimulating hormone and T4 to detect hypo‑ or hyperthyroidism
• Iron studies if anemia is present; vitamin B12 and folate may be measured;
• Pap and HPV tests – screen for cervical abnormalities.
• Transvaginal ultrasound uses sound waves to create images of your uterus and ovaries and can detect fibroids, polyps or a thickened endometrium
• Saline infusion sonohysterogram places sterile saline in the uterus during ultrasound for a better view of the cavity
• Hysteroscopy is a procedure in which a thin scope is inserted through the cervix to look directly inside the uterus and remove polyps or fibroids
• Endometrial biopsy takes a small sample of the uterine lining to check for precancer or cancer
You should see a doctor if you soak through a pad or tampon every hour for several hours, pass large clots, bleed for more than 7 days, bleed between periods or after sex, or have bleeding after menopause. Seek care right away if you feel dizzy, faint, short of breath, have chest pain or severe pelvic pain—these can be signs of heavy blood loss or other serious conditions.
Follow-up depends on the cause of your bleeding. After starting medications, your doctor may want to see you in 1–3 months to check if your periods have normalized and adjust treatment. If you have an IUD or hormone therapy, visits every 3–6 months are common. Continue routine pelvic exams and Pap/HPV screening as recommended for your age.
There is no guaranteed way to prevent all menstrual irregularities, but keeping your body healthy can help regulate cycles. Maintain a healthy weight and eat a balanced diet rich in fruits, vegetables, whole grains and lean proteins. Regular exercise may ease cramps and improve mood, but very intense training or rapid weight loss can cause irregular or missed periods, so aim for a moderate amount of physical activity. Managing stress through yoga, meditation or counseling, and avoiding smoking and excessive alcohol, can also support hormonal balance. If you have a condition like PCOS, diabetes or thyroid disease, working with your provider to control it can improve your menstrual health.
Your primary care doctor may refer you to a gynecologist if heavy or irregular bleeding persists or if imaging shows fibroids or polyps. An endocrinologist can help manage hormone disorders such as thyroid disease or polycystic ovary syndrome. A hematologist may be consulted if a bleeding disorder is suspected. Dietitians and mental health counselors can assist with weight management and stress reduction. Your provider will coordinate with these specialists and keep track of your care plan.