Irregular periods and abnormal uterine bleeding

For a lay person:

Abnormal uterine bleeding is bleeding from the womb that is heavier, longer, more frequent or less predictable than normal. It is common around the start of periods and before menopause, when hormone changes stop regular ovulation, but it can also be caused by fibroids, polyps and other conditions.

For a trained medical person:

Classified by the PALM-COEIN system into structural causes (polyps, adenomyosis, leiomyoma, malignancy) and non-structural causes (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic and other); anovulatory bleeding was previously called dysfunctional uterine bleeding. Work-up includes pregnancy test, full blood count, thyroid and coagulation testing as indicated, pelvic ultrasound and endometrial sampling for those at risk of hyperplasia. Treatment includes hormonal therapy, the levonorgestrel IUS, tranexamic acid or NSAIDs, iron replacement and procedures for structural causes.

In Chinese medicine:

Liu and Tseng's textbook differentiates this condition into these patterns: Kidney Yin Deficiency; Nourish Kidney and stabilize Chong channel; Kidney Yang Deficiency; Warm Kidney and stabilize Chong channel; Spleen Deficiency; Blood-Heat; Blood Stasis; Anovulatory Type; Yin Deficiency with Blood-Heat; Liver Qi Stagnation and Blood-Heat; Internal Accumulation of Damp-Heat. Treatment follows the pattern a patient presents with, not the Western diagnosis alone.

When to get help: Get urgent care for soaking a pad an hour for several hours, dizziness or fainting, or bleeding in pregnancy; see a doctor for bleeding after menopause or between periods. Blood-moving herbs can increase bleeding and should be avoided with anticoagulants.