Abnormal Uterine Bleeding
This page is part of our comprehensive menopause and perimenopause care resource for women on the North Shore. If you are experiencing irregular cycles in your 40s, visit our perimenopause symptoms page. If your periods have stopped for 12 months, see our menopause care resource.
What Is Abnormal Uterine Bleeding?
Abnormal uterine bleeding refers to menstrual bleeding that differs from your usual pattern in timing, frequency, duration, or volume.
It may include:
Very heavy periods
Bleeding between periods
Periods lasting longer than usual
Cycles occurring too close together
Bleeding after menopause
Some changes are common during perimenopause. Others require prompt medical evaluation.
Women in Salem, Peabody, Beverly, Danvers, Lynn, and surrounding Essex County communities often seek care when bleeding becomes disruptive or concerning.
What Is Considered a Heavy Period?
A period may be considered heavy if you:
Soak through a pad or tampon every 1 to 2 hours
Need to double up on protection
Pass large blood clots
Bleed longer than 7 days
Feel fatigued or lightheaded during your cycle
Heavy bleeding can affect work, sleep, and daily activities. It may also lead to iron deficiency anemia.
Bleeding Between Periods
Spotting or bleeding between cycles is not considered typical and should be evaluated.
Common causes may include:
Hormone fluctuations
Polyps
Fibroids
Thyroid disorders
Infection
An evaluation helps determine whether additional testing is needed.
Abnormal Bleeding During Perimenopause
Irregular and sometimes heavy bleeding is common during perimenopause due to fluctuating hormone levels.
You may notice:
Skipped cycles followed by heavy bleeding
Cycles that are shorter or longer than usual
Unpredictable flow patterns
Although some irregularity is expected during this stage, very heavy or prolonged bleeding should still be assessed.
Learn more about perimenopause symptoms and treatment.
Bleeding After Menopause
Bleeding after menopause is never considered normal. Menopause is defined as 12 consecutive months without a period. Any vaginal bleeding after that point requires medical evaluation.
Possible causes may include:
Vaginal or endometrial atrophy
Polyps
Endometrial hyperplasia
Endometrial cancer
Most cases are not cancer, but evaluation is essential to rule out serious conditions. Dr. Barry Burrows explains, “Postmenopausal bleeding should always be assessed. While many causes are benign, we do not ignore bleeding after menopause.”
If you are postmenopausal and notice bleeding, schedule an appointment promptly.
How Abnormal Uterine Bleeding Is Evaluated
Evaluation typically begins with a detailed medical history and physical examination.
Depending on your symptoms and age, additional testing may include:
Blood work
Pelvic ultrasound
Endometrial biopsy
Hysteroscopy in certain cases
Testing recommendations vary based on individual risk factors and clinical findings.
Treatment Options for Abnormal Bleeding
Treatment depends on the underlying cause, age, and reproductive goals.
Options may include:
Hormonal therapies to regulate cycles
Non-hormonal medications to reduce bleeding
In-office procedures
Surgical options in certain situations
If heavy bleeding is related to perimenopause, cycle regulation strategies may help. Learn more on our perimenopause page.
If bleeding occurs after menopause, treatment is guided by evaluation findings.
When to Seek Immediate Care
Seek prompt medical attention if you experience:
Bleeding after menopause
Soaking through protection every hour for several hours
Dizziness or fainting
Severe pelvic pain
If symptoms are urgent, contact your provider or seek emergency care.
Frequently Asked Questions
Are heavy periods normal in your 40s?
Cycle changes are common during perimenopause, but very heavy or prolonged bleeding should be evaluated.
Is spotting between periods serious?
Spotting may have several causes. Evaluation helps determine whether further testing is needed.
What causes bleeding after menopause?
Causes may include atrophic changes, polyps, or endometrial conditions. Postmenopausal bleeding always requires assessment.
Can hormone therapy cause abnormal bleeding?
Some hormone regimens may cause spotting, especially early in treatment. Persistent or heavy bleeding should be discussed with your clinician.
Abnormal Uterine Bleeding Evaluation on the North Shore
If you live in Essex County or anywhere on Boston’s North Shore and are experiencing heavy periods, irregular bleeding, or bleeding after menopause, our women’s health team provides thorough evaluation and individualized treatment planning.
We coordinate care with gynecology and primary care to ensure appropriate follow-up and long-term management.
Schedule an appointment to discuss your symptoms and next steps.