Abnormal uterine bleeding describes any bleeding from the uterus that is unusually heavy, prolonged, irregular or occurs outside the normal menstrual cycle. It is one of the most common reasons women are referred to a gynaecologist and can significantly affect day-to-day life, work and wellbeing.

There are many possible causes, including hormonal imbalance, fibroids, polyps, adenomyosis, thyroid or clotting disorders, and — less commonly — changes to the lining of the uterus that need further evaluation. Bleeding after menopause always warrants assessment.

Investigation typically includes a careful history, blood tests, and a pelvic ultrasound. In some cases a hysteroscopy — a brief procedure to look directly inside the uterus and take a small sample — is recommended.

Treatment is tailored to the cause and to your priorities. Options include hormonal medications, the hormonal IUD, non-hormonal tablets to reduce blood loss, hysteroscopic procedures to remove polyps or fibroids, endometrial ablation, or hysterectomy where other approaches have not helped.