Can't get by on a tampon?

You're not alone.

Yes, normal periods exist. Those who suffer from Abnormal Uterine Bleeding (AUB) don’t have them.

C'mon! Just use a tampon!

"C'mon! Just use a tampon!"

What is a “normal” period?

Periods vary from person to person. However, there is an average when it comes to the amount of blood loss during menstruation.

*Bleeding before your first period (menarche), after menopause, or during pregnancy is not addressed in this overview of AUB

Typical menstruation Typical menstruation

During typical menstruation, the uterus sheds 37-41mLs of blood over the first 5–7 days of the menstrual cycle (2.5-2.7 tablespoons)

AUB menstruation AUB menstruation

Women with AUB average between 100-130mLs over a variable number of days(6.7-8.8 tablespoons)

So, women with AUB bleed about 3 times more than women who don’t have AUB.

(Are you thinking there is NO WAY you only shed 8 tablespoons? We hear you.)

Did you know?

Did You Know...

One-third of outpatient visits to the gynecologist are for AUB. One-third of outpatient visits to the gynecologist are for AUB.

One-third of outpatient visits to the gynecologist are for AUB

(During perimenopause that number rises to over 70%!)1

Chronic does not mean OK

Over time, many women accept or ignore symptoms of AUB. Some don’t have time to deal with it. Others can’t take off work to see a doctor or don’t believe there’s a treatment for them. While still others believe that it may be hereditary and there’s nothing that can be done.

These are all reasons why women delay getting a diagnosis.

But imagine how much easier life would be, and how much better you would feel, if you knew what was causing your symptoms. And you knew which treatment options were the best fit based on your exact diagnosis.

How do doctors diagnose AUB?

It depends on the doctor.

If you’re seeing a general practitioner, blood work may be the first and only step before they refer you to a gynecologist. Blood work can include ruling out pregnancy, checking your blood’s clotting capabilities, testing for anemia and measuring your thyroid levels.

When you see a gynecologist, you’ll be able to have a more thorough exam, which should be based on the PALM-COEIN classification system. It sounds complicated, but PALM-COEIN actually simplifies your AUB diagnosis. And it makes sure that everyone is speaking the same language.

PALM-COEIN System

for Classification of Causes of AUB in the Reproductive Years.

PALM: Polyps, Adenomyosis, Leiomyoma (Fibroids), Malignancy & Hyperplasia

P.A.L.M.

PolypsNon-cancerous growths on the lining of the uterus and/or cervix

AdenomyosisEndometrial tissue that is present within and grows into the muscular walls of your uterus

Leiomyoma (Fibroids)Noncancerous growths of muscle in the uterus

Malignancy & HyperplasiaCancerous growths or atypical pre-cancerous endometrial tissue

COEIN: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified

C.O.E.I.N.

CoagulopathyThe blood’s ability to coagulate (form clots) is impaired

Ovulatory dysfunctionAbnormal, irregular (with ≤ 9 periods/year), or absent ovulation

EndometrialThickening of the lining of the uterus, or endometrium due to hormonal fluctuations

IatrogenicCaused by medical interventions (for example, the placement of an IUD) or certain medications

Not otherwise classified*Rare conditions, or those not identifiable as related to the AUB symptoms

*Conditions to be included in not otherwise classified include pelvic inflammatory disease, chronic liver disease, and cervicitis.

Learn more about AUB causes

Your AUB diagnostic consultation

The first step toward getting a diagnosis is to tell your doctor what your symptoms are, how they impact you during your menstrual cycle and any related family history.

The next step is to have an examination of your uterus.

How physicians see the uterine cavity

Hysteroscopy

To see the interior of the uterine cavity, physicians use a hysteroscope. With this tool, your physician directly views the inside of your uterus using a tiny camera attached to a thin wand. (Some gynecologists offer hysteroscopies in the office, which is really convenient.)

Ultrasound

Your gynecologist may choose to do a transabdominal ultrasound or a transvaginal ultrasound. This is a good start, but ultrasounds don’t show everything. And sometimes what they show can’t be classified.

Saline infusion sonography (Sonohysterogram)

During transvaginal ultrasound, your physician delivers saline into the uterine cavity through the vagina and cervix. This expands the cavity, enabling the physician to better see the ultrasound images of the uterus and any tissue growths, if present.

MRI

Not all causes of AUB are visible from within the uterine cavity, though. For example, some fibroids or endometrial tissue can be in the walls of the uterus. If your doctor doesn’t visually identify a cause in your uterus, they may suggest having an MRI, which will provide a much more detailed image of your whole uterus, not just the interior of the cavity.

All these efforts are designed to definitively diagnose the cause of your AUB. And that’s really important. Because when you are experiencing a health condition and don’t have a clear understanding of what’s happening in your body, you may experience stress. On top of AUB.

No one needs that.

Download a Discussion Guide

Have the most productive consultation about your period ever

This AUB discussion guide is a great place to note your symptoms so you don’t forget to mention them all (we’ve been there). It also includes questions to ask and definitions of some terms you may hear during your consultation, and more–so you make the best use of your time.

Download AUB & Me Guide

How AUB impacts fertility

Show me

The American Society for Reproductive Medicine notes there are several ways uterine fibroids and polyps can reduce fertility:

Several ways uterine fibroids can reduce fertility. Several ways uterine fibroids can reduce fertility.

Though studies have not been conducted to confirm how polyps affect fertility, it is theorized that polyps interfere with or impede the planting of the embryo in the uterine lining.

Download “AUB and Fertility” guide

How do you treat AUB?

In the past, the burden has been placed on women to manage a debilitating but treatable condition.

Left untreated, AUB often results in a hysterectomy.2

A hysterectomy is an invasive surgery with potential long term complications. Today, women have less invasive options, thanks to advancements in gynecologic care.

Now you can treat AUB without hormones, while preserving your uterus.

How to treat AUB

You deserve to be heard

A consultation with a gynecologist who understands AUB is what you need and deserve.

Locate an AUB expert

AUB FAQs

What is AUB?

Abnormal uterine bleeding (AUB) is menstrual bleeding of abnormal quantity, duration, or schedule. It’s a common gynecologic condition affecting 1 in 3 women during their life.* While sometimes referred to as heavy menstrual bleeding (HMB), AUB is more complex than excessive menstrual bleeding. AUB can severely impact a woman’s quality of life, and it can also affect fertility.

*Davis E, Sparzak PB. Abnormal Uterine Bleeding. 2021 Feb 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-Feb 10. PMID: 30422508. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532913/

What causes AUB?

Diagnosing the cause of AUB is a complex process. Causes of AUB are sorted into structural and non-structural categories:

AUB-L and AUB-P: The most common structural causes of AUB are fibroids (AUB-L) and polyps (AUB-P).

AUB-E: A thick endometrium is an example of non-structural AUB and is typically caused by hormonal fluctuations that lead to changes in the shedding and repairing of the endometrium (AUB-E).

When doctors diagnose the root cause of a patient’s AUB, they use the PALM-COIEN classification system. This method simplifies and defines the diagnosis and helps patients research their specific condition and the treatment path best suited for them.

There’s limited conclusive evidence on what exactly causes some conditions that result in AUB. For instance, there is no definitive understanding of what causes fibroids and other tissue-growth conditions of the uterus. Given the severity of the symptoms associated with AUB, and its impact on fertility and overall quality of life, Minerva has committed to support future uterine health research.

Click here for more information on the causes of AUB.

Is my period normal or heavy?

A normal period is one that rarely interferes with your daily life. You’ll need to change pads or tampons as recommended, but you’re not bleeding through them in two hours. You can maintain your typical schedule, enjoy your favorite activities and work is rarely impacted by your period.

Your bleeding is heavy if you

  • bleed through pads or tampons in two hours
  • need to use both a pad and tampon regularly
  • wake up to change pads or tampons during the night
  • collect more than 30 mLs of blood in your menstrual cup
  • bleed through your clothes
  • routinely pack a just-in-case bag when you head out 
  • cancel plans or call in sick
  • schedule your life around your period

If you are passing blood clots and soaking through your usual pads or tampons each hour for two or more hours, your bleeding is considered severe, and in some cases, this can lead to anemia. You may benefit from seeing a gynecologist who understands AUB.

Click here for more information on diagnosing AUB.

When are heavy periods a problem?

When they interfere with your life experience. That’s the signal to consult a gynecologist to see if you have AUB, and if so, what the cause may be.

Once you know what is causing your AUB symptoms, you can make informed choices about your treatment path. This is important because not all gynecologists offer minimally invasive solutions for fibroid removal and instead offer a less effective alternative, like hormonal drug therapy. Or they go to the opposite extreme and suggest a hysterectomy.

If you are experiencing heavy periods, you have options that don’t require implants (IUDs, for example), invasive surgery or hormones. Seeing the right gynecologist is the first step. There are uterine-sparing, non-hormonal treatment options that are safe and effective and may be appropriate to treat your AUB. Find a physician who understands AUB

How is AUB diagnosed?

To accurately diagnose AUB, your gynecologist will want to run blood tests and conduct an imaging assessment of your uterus. An accurate procedure for diagnosing fibroids and polyps in the uterine cavity is called a “hysteroscopy”, during which polyps can be removed. If fibroids are present, your gynecologist will discuss the options for their removal.

Click here for more information on diagnosing AUB.

Why do physicians prescribe birth control pills for heavy periods?

Because some women experience high levels of estrogen and low levels of progesterone. This can cause the endometrium, or uterine lining, to thicken. When the endometrium sheds during menstruation, women might experience heavier blood flows and larger blood clots.

Why not get a hysterectomy to treat AUB?

Hysterectomies may have long term side effects, the extent of which is not fully understood. In a recent Mayo Clinic study, women who had their uterus removed, leaving the ovaries, had a 33% increased risk of coronary artery disease. Furthermore, women under the age of 35 had a 4.6-fold increased risk of congestive heart failure.* While in some cases a hysterectomy is required, 68% of all hysterectomies are for benign reasons, for which there are other less invasive options.**

Minerva is committed to providing technologically advanced, minimally invasive treatment options that preserve the uterus, and Minerva supports continued research on uterine health.

*Laughlin-Tommaso SK, et al. Cardiovascular and metabolic morbidity after hysterectomy with ovarian conservation: a cohort study. Menopause. 2018 May;25(5):483-492. https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC5898981/pdf/nihms918518.pdf

**https://labblog.uofmhealth.org/rounds/plotting-downward-trend-traditional-hysterectomy

  1. Spencer CP, Whitehead MI. Endometrial Assessment Re-visited. Br J Obstet Gynaecol. 1999 Jul;106(7):623-32. doi: 10.1111/j.1471-0528.1999.tb08358.x. PMID: 10428515. Last accessed July 28, 2021.
  2. Plotting the Downward Trend in Traditional Hysterectomy, https://labblog.uofmhealth.org. Last accessed July 28, 2021