Every woman's menstrual cycle, or period, is different. On average, a woman's period occurs every 28 days. Most women have cycles between 24 and 34 days apart. It usually lasts 4 - 7 days.
Young girls may get their periods anywhere from 21 to 45 days or more apart. Women in their 40s will often notice their period occurring less often.
About every month, the levels of female hormones in a woman's body rise and fall. Estrogen and progesterone are two very important hormones. These hormones play an important role in ovulation, the time when the ovaries release an egg.
Dysfunctional uterine bleeding (DUB) most commonly occurs when the ovaries do not release an egg. Changes in hormone levels cause your period to be later or earlier and sometimes heavier than normal.
See also: Vaginal bleeding
Symptoms of dysfunctional uterine bleeding may include:
Bleeding or spotting from the vagina between periods
Periods that occur less than 28 days apart (more common) or more than 35 days apart
Time between periods changes each month
Heavier bleeding (such as passing large clots, needing to change protection during the night, soaking through a sanitary pad or tampon every hour for 2 - 3 hours in a row)
Bleeding lasts for more days than normal or for more than 7 days
Other symptoms caused by changes in hormone levels may include:
Excessive growth of body hair in a male pattern (hirsutism)
Tenderness and dryness of the vagina
A woman may feel tired or have fatigue if she is loses too much blood over time. This is a symptom of anemia.
Signs and tests
The health care provider will do a pelvic examination and may perform a Pap smear. Tests that may be done include:
Kaunitz AM, Meredith S, Inki P, Kubba A, Sanchez-Ramos L. Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis. Obstet Gynecol. 2009;113:1104-1116.
Casablanca Y. Management of dysfunctional uterine bleeding. Obstet Gynecol Clin North Am. 2008;35:219-234.
Damlo S. ACOG guidelines on endometrial ablation. Am Fam Physician. 2008;77:545-549.
ACOG Practice Bulletin No. 110: noncontraceptive uses of hormonal contraceptives. Obstet Gynecol. 2010 Jan;115(1):206-18.
Middleton LJ, Champaneria R, Daniels JP, Bhattacharya S, Cooper KG, Hilken NH, et al. Hysterectomy, endometrial destruction, and levonorgestrel releasing intrauterine system (Mirena) for heavy menstrual bleeding: systematic review and meta-analysis of data from individual patients. BMJ. 2010 Aug 16;341:c3929. doi: 10.1136/bmj.c3929.
David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine.