REDUCING THE CONFUSION ABOUT ABNORMAL UTERINE BLEEDING

 

 

Dr Steven R. Goldstein is a Gynecologist in Manhattan who has helped thousands of women with abnormal uterine bleeding (AUB). If you've ever felt confused about your period — whether it's coming too often, lasting too long, or showing up when it's not supposed to — you're not alone. As an abnormal uterine bleeding specialist NYC, Dr Goldstein sees women every day who are frustrated, concerned, or just plain tired of dealing with unpredictable cycles and abnormal bleeding.

 

Let’s break down what’s normal, what’s not, and what could be going on if your period seems to be writing its own rules.

 

What Is Abnormal Uterine Bleeding (AUB)?

Abnormal Uterine Bleeding, or AUB, is a medical term we use when bleeding from the uterus doesn't follow a typical menstrual pattern. That might mean:

• Your period comes too often
• It lasts longer than usual
• You bleed between periods
• Your flow is much heavier or lighter than normal
  
  

While these symptoms might feel alarming, the good news is there are usually explanations — and treatments — available.

 

Types of Abnormal Bleeding

Let’s go over some common patterns of abnormal bleeding and what they mean in plain language:

1.    Intermenstrual Bleeding
This is when you bleed between your regular periods. Spotting now and then can be normal, especially if you're on birth control, but frequent or heavy mid-cycle bleeding should be checked out.

2.    Metrorrhagia
This refers to bleeding that’s irregular — you might bleed a little one week, then nothing for a few days, then bleed again. It’s unpredictable and can be frustrating.

3.    Menorrhagia
This is the medical term for periods that are too heavy but come at regular intervals. If you're soaking through a pad or tampon every hour or passing large clots, that qualifies as heavy.

4.    Polymenorrhea
If your period comes too frequently — less than 21 days apart — this is called polymenorrhea. That’s more than one period a month, and it can be exhausting.

5.    Oligomenorrhea
This is the opposite — periods that are too far apart, more than 37 days between them. While some women naturally have longer cycles, a sudden change can be a sign of a hormonal issue or another underlying problem.

 

What Causes Abnormal Uterine Bleeding?

There are many possible reasons why your uterus may be misbehaving. Some are temporary, while others may need medical treatment. Here are a few of the most common culprits:

 

1. Hormonal Imbalances

Your menstrual cycle is controlled by hormones. If something throws them off — like stress, weight changes, thyroid issues, or polycystic ovary syndrome (PCOS) — it can lead to irregular bleeding.

2. Anovulation (Not Ovulating)

If you're not ovulating regularly, your periods may become irregular or unusually heavy. This kind of bleeding is often referred to as “dysfunctional” because it’s not following the usual monthly cycle. Anovulatory cycles are especially common during puberty and perimenopause.

3. Uterine Fibroids (Leiomyomas)

Fibroids are non-cancerous growths in the uterus. They’re common — especially in women in their 30s and 40s — and they can cause heavy or prolonged periods. Fibroids that grow inside the uterine lining (called submucosal fibroids) are particularly known to cause bleeding.

Interestingly, we don’t fully understand why fibroids cause bleeding, but one reason may be that as they grow, they increase the surface area inside your uterus. More surface = more bleeding.

4. Pregnancy-Related Bleeding

Always rule out pregnancy first! Even if you weren’t trying to conceive, unexpected bleeding might be related to pregnancy or even a miscarriage.

5. Other Causes

Sometimes, bleeding can come from the cervix or vagina, not the uterus. Infections, inflammation, or, in rare cases, precancerous or cancerous changes could be the source. This is why it’s so important to get checked if you notice something unusual.

 

When Should You See a Doctor?

Here are a few signs it’s time to book an appointment:

• You bleed between periods more than once or twice
• Your period is coming too often or skipping months
• You’re soaking through pads/tampons every hour
• You’ve noticed a big change in your cycle
• You’re feeling tired, dizzy, or weak (which could mean anemia from blood loss)

 

What Can Be Done?

The treatment for Abnormal Uterine Bleeding depends on the cause. Your period is a window into your overall health. If something seems off, don’t ignore it. As an abnormal uterine bleeding specialist in NYC, Dr Goldstein is here to help you figure out what’s going on and how to get things back on track.

 

To determine the cause of the abnormal uterine bleeding, Dr Goldstein uses minimally invasive, painless transvaginal ultrasounds or Sonohysterograms to see the uterus, uterine lining, fallopian tubes, ovaries, cervix live. He is known as pioneer in the field of gynecologic ultrasounds and personally performs all these procedures.

 

Dr Goldstein, a leading Gynecologist in Manhattan encourages women not to suffer in silence. Irregular or heavy periods are not something you “just have to live with.” There are solutions, and we’re here to help you find them.

 

Perimenopause and the Biological Clock

  

Dr Steven R. Goldstein is a Perimenopause Specialist NYC who has helped thousands of women navigate Perimenopause, the transitional phase to Menopause. From the late thirties to the late forties, women may enter Perimenopause, which is a preparatory stage for menopause, both biologically and symptomatically.

 

Women in their late thirties or forties who are not yet married often ask about the “Biological clock”.  The term "biological clock" is more than just a phrase—it refers to the natural, age-related decline in fertility that women experience over time.

 

From a medical standpoint, a woman is born with all the eggs she will ever have—around 1 to 2 million at birth. By puberty, that number drops to about 300,000. With each menstrual cycle, a group of eggs begins to mature, but typically only one reaches ovulation. Over time, both the quantity and quality of these eggs diminish.

 

This decline becomes more noticeable in a woman’s mid-30s, and by the time she reaches her early 40s, fertility has significantly decreased. It's not just about getting pregnant—it's also about a higher risk of miscarriage, chromosomal abnormalities like Down syndrome, and complications during pregnancy. The "biological clock" isn’t meant to pressure or scare—it’s simply a biological reality.

 

Dr Steven R. Goldstein, a Perimenopause Specialist NYC says that a woman’s chance of conceiving naturally within a year over the age of forty is 25 to 30 percent. Still, midlife motherhood is definitely on the rise. Dr Goldstein has had patients in their late thirties and early forties who conceived the first time they had unprotected sex, merely by carefully charting their menstrual cycles and copulating on the appropriate days. However, it’s estimated that 75 percent of women over forty will need some help from technology to conceive.

 

What makes it so difficult to have a baby during Perimenopause? First and foremost, you may not ovulate every month, giving you fewer chances to become pregnant. Next, women simply have fewer and older, less viable eggs. By the time of Perimenopause, it is estimated that she has about ten thousand left. Less viable eggs are those that are harder for sperm to penetrate.

 

Some women have scar tissue that comes from the ovary having to repair itself after each ovulatory cycle. The more difficult a time the egg has navigating thru this scar tissue to the place where it can be released, the more difficult conception becomes. Scarring can also come from pelvic inflammatory disease, caused by sexually transmitted disease such as chlamydia. If it goes untreated for long, it can cause enough scarring to block the fallopian tubes or damage the ovaries. The fallopian tubes, which link the ovaries to the uterus, must be unobstructed for pregnancy to occur.

 

The cervix can also cause problems. If it is scarred from previous childbirths or narrowed for any reason, it can block the sperm from reaching the egg. In rare cases, a woman’s cervical mucosa contains substances that immobilize sperm.

 

Many women of Perimenopausal age have had gynecological surgery. If you’ve had a fibroid or some other benign growth removed, there may be scar tissue as a result.

 

Your body is probably still making estrogen in perimenopause – and progesterone when you ovulate. But how high are those levels? It’s not uncommon for women to find that they don’t secrete enough progesterone to prepare the endometrium for the fertilized egg. The egg can’t embed itself, and therefore no pregnancy ensues. This condition is sometimes called “luteal phase deficiency”.

 

If you are perimenopausal and the state of your fertility is important for you to know, the use of follicle stimulating hormone (FSH) measurements on day three of your cycle is the trick of the reproductive endocrinologist. It has been noted that if FSH on day three of the cycle is already climbing (20 or greater), then the patient’s chances of conceiving naturally are not very good.

 

If you are thirty five plus, have decided you want to pursue pregnancy, and you know that you are not ovulating regularly, see a specialist as soon as you can if you fail to get pregnant after six months of having intercourse the time of ovulation. You will need to pursue a structured plan to overcome fertility problems.

 

If you are perimenopausal and considering pregnancy, then perhaps a consultation with Dr Steven R. Goldstein, a Perimenopause Specialist NYC  may be in order. Dr Goldstein is a past President of The Menopause Society and the International Menopause Society. He is also a Certified Menopause Practitioner and considered one of America’s top gynecologists.