Abnormal Bleeding Between Periods: When to Call Your OB/GYN

 

About one in three women seeks treatment for heavy periods at some point, according to the American College of Obstetricians and Gynecologists (ACOG). Add in spotting between cycles, shifts during perimenopause, and bleeding after menopause, and abnormal bleeding turns out to be one of the most common reasons women see a gynecologist.

Even so, plenty of women wait months or years to bring it up. Some assume heavy periods are just how their body works. Others aren’t sure the change is big enough to mention.

Most causes are very treatable, and a few types of bleeding always deserve a prompt call. Knowing the difference makes the next step much easier.

What Counts as Abnormal Bleeding?

Every individual’s body has its own rhythm, so “normal” covers a pretty wide range. In general, a typical cycle runs about 21 to 35 days, with bleeding that lasts up to 7 days.

Bleeding may be considered abnormal if you notice:

• Abnormal bleeding between periods, including light spotting
• Bleeding after sex
• Periods that come much more or less often than usual
• Periods that are much heavier or last longer than your baseline
• Any bleeding after menopause

A single off month isn’t usually cause for alarm, since stress, travel, and illness can all throw a cycle off. A pattern that lasts two or three months is worth bringing to your provider.

When Is Menstrual Bleeding Too Heavy?

Many women have lived with heavy periods for so long that they assume it’s just how their body works. But heavy bleeding isn’t something you have to put up with, and it can lead to iron-deficiency anemia over time.

According to ACOG, signs your period may be too heavy include:

• Soaking through one or more pads or tampons every hour for several hours in a row
• Needing to double up on pads, or a pad and a tampon together
• Passing clots the size of a quarter or larger
• Bleeding for more than 7 days
• Waking up at night to change protection

Feeling unusually tired, short of breath, or lightheaded during or after your period can also be a sign of blood loss worth checking.

Heavy Periods: When to See a Doctor

If any of the signs above sound familiar, schedule a visit with your provider. A rough record of your last few cycles, including dates, how many pads or tampons you used, and any clots you passed, helps a lot. A period tracking app makes this easy.

Some situations need care right away. Seek emergency care if you’re soaking through a pad or tampon every hour for more than two hours and also feel dizzy, faint, short of breath, or have chest pain. Bleeding during a known or possible pregnancy also needs prompt attention.

Call 911 in an emergency. UAB Medical West’s main campus Emergency Department in Bessemer and our Freestanding Emergency Department in Hoover are both open 24/7.

Irregular Periods: Causes to Know About

Abnormal bleeding has a long list of possible causes, and most of them aren’t serious. Some of the most common irregular period causes include:

• Hormone changes during the teen years and perimenopause, when ovulation can be unpredictable
• Polycystic ovary syndrome (PCOS) or other ovulation problems
• Thyroid conditions, which can make periods heavier, lighter, or less regular
• Fibroids and polyps, noncancerous growths in or on the uterus
• Adenomyosis or endometriosis, which can cause heavy, painful periods
• Birth control changes, including starting or stopping the pill or using a copper IUD
• Medications like blood thinners
• Bleeding disorders, especially if heavy periods started with your very first period
• Pregnancy-related causes, so a pregnancy test is often one of the first steps

Less often, abnormal bleeding can signal precancerous changes or cancer of the uterus. Most cases don’t end up there, but it’s one reason a checkup matters.

Why Bleeding After Menopause Always Needs a Checkup

Once you’ve gone 12 months without a period, you’ve reached menopause. Bleeding after menopause, even light spotting or a single episode, should always be evaluated.

Most of the time, the cause is something manageable, like thinning tissue in the vagina or uterus, or a polyp. Still, ACOG notes that about 90% of people diagnosed with endometrial cancer first noticed bleeding after menopause, and the cancer is often highly treatable when it’s caught early. Don’t wait to see if it happens again.

What Testing May Include

Testing depends on your age, your symptoms, and your history. Your provider will usually start with a conversation about your cycle, then may recommend:

• A pelvic exam to check for anything visible, like a polyp or infection
• A pregnancy test, if there’s any chance you could be pregnant
• Blood tests to check for anemia, thyroid problems, or clotting issues
• A pelvic or transvaginal ultrasound to look at the uterus and ovaries
• An endometrial biopsy, which takes a small sample of the uterine lining, is performed in the office
• A hysteroscopy, which uses a thin camera to look inside the uterus

For bleeding after menopause, ACOG’s updated 2026 guidance recommends that most women have both a transvaginal ultrasound and an endometrial biopsy as part of their first evaluation. Our Diagnostic Imaging team provides pelvic and transvaginal ultrasound on the main campus.

Seeing an OB/GYN for Abnormal Bleeding

Your primary care provider can be a good first stop, but an OB/GYN for abnormal bleeding brings focused experience and can handle most testing and treatment in one place.

Treatment depends on the cause. Options range from hormonal birth control or an IUD to iron supplements, medication to reduce heavy flow, or a minor procedure to remove a polyp or fibroid.

Talking about bleeding can feel awkward, but your provider has heard it all and is there to help you feel like yourself again.

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Get Answers About Abnormal Bleeding

The UAB Medical West OB/GYN team evaluates and treats abnormal bleeding for women in Bessemer, Hoover, and across West Jefferson County.

If something about your cycle has changed, we’d be glad to help you find answers.