When is Bleeding Abnormal


What is normal when it comes to a period?


It’s estimated that 1.4 million women in the US will experience abnormal uterine bleeding (AUB) each year. For women in perimenopause, about  half or 50% of will experience irregular and/or heavy bleeding. Heavy menstrual bleeding and/or periods that show up unexpectedly can wreak havoc in a woman’s life.


Many women are busy juggling lots of demands on their time and figure that the bleeding will stop or become regular. Others are concerned about how we diagnose the issues and what types of treatments are available. Many are just too busy to get this evaluated, which is understandable.


Here at El Camino Women’s Medical Group, in most cases we can evaluate and treat a woman’s bleeding right here in our office. So please don’t let worry or concerns interfere with you getting the care you need.


How do we define Abnormal Uterine Bleeding?


The American Congress of Obstetricians and Gynecologists (ACOG) defines Abnormal Uterine Bleeding this way:


ACOG Definition of Abnormal Uterine Bleeding (AUB)



  • Bleeding that requires more than 1 pad/hour for more than 1 day
  • Bleeding for more than 7 days at a time
  • Bleeding intervals that are less than 20 days apart
  • Bleeding in excess of 80 cc a month
    • a super tampon or pad can hold approximately 10 cc of blood
  • Bleeding that causes anemia
  • Bleeding that leads to disruption in life style



Source: ACOG, Committee Opinion. April 2013 (reaffirmed 2015), number 557.

When evaluating women with bleeding, the very first test that’s done on women under 60 is a pregnancy test. Pregnancy is still one of the most common causes of bleeding in women of reproductive age.


Once it’s determined that the woman isn’t pregnant, our providers may recommend lab testing and an ultrasound.


If it’s necessary to look inside the uterus, we use an in-office camera, known as Endosee® that is attached to a small smart phone sized screen to visualize the inside of the uterine cavity. This can be done in the office in less than 30 minutes. This saves women valuable time and reduces costs, because what was once In In addition, women who have abnormal bleeding may need to have an endometrial biopsy to make sure there isn’t any abnormal cell growth that could be causing the bleeding.


For both the Endosee and an Endometrial biopsy, we use a numbing medicine to reduce discomfort, and most women are able to return to their normal routines within a few hours.


If you have any bleeding that’s heavy, prolonged or if you have any concerns, please do make an appointment with one of our providers.

El Camino Women’s Medical Group offers the latest Minimally Invasive Solutions for gynecologic problems.   Drs. Amy TengErika Balassiano, and Pooja Gupta, all members of AAGL (American Association of Gynecologic Laparoscopy) are highly trained and experienced in the field of Minimally Invasive Gynecgologic Surgery.   Dr. Erika Balassiano is also a graduate of the Minimally Invasive Gynecologic Surgery Fellowship at Stanford University, under the supervision of world-renowned Dr. Camran Nezhat.


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