Table 1.
Causes of Menstrual Irregularity/Abnormal Uterine Bleeding, Including Frequent Bleeding, Infrequent Bleeding, Intermenstrual Bleeding, or Postcoital Bleeding
| Anovulation |
| Polycystic ovarian syndrome |
| Stress – hypothalamic |
| Excessive exercise |
| Eating disorders |
| Anorexia nervosa |
| Bulimia |
| Hormonal conditions |
| Cushing's disease |
| Hyperprolactinemia |
| Thyroid disease |
| Chronic Illnesses |
| Diabetes mellitus, especially if poorly controlled |
| Inflammatory bowel disease |
| Kidney (renal) disease |
| Liver disease |
| Ovarian insufficiency – sometimes called ovarian failure, premature ovarian failure, or premature menopause |
| Pituitary conditions |
| Pituitary tumors (adenomas), such as prolactinoma |
| Cervical Conditions |
| Cervical cancer |
| Cervical infection (cervicitis) – may be caused by sexually transmitted diseases, including gonorrhea, Chlamydia, and Trichomonas |
| Cervical polyp |
| Endometrial Conditions |
| Endometrial cancer |
| Endometrial hyperplasia |
| Endometrial infection (endometritis) |
| Endometrial polyp |
| Endometriosis or adenomyosis |
| Hormonal Therapies |
| Breakthrough bleeding (unscheduled bleeding) |
| Birth control pills (oral contraceptives); most likely during the first few months of use; when taken late or missed; when used in smokers; with extended cycle regimens (84/7 trimonthly or 365-day regimen) |
| Birth control patch or ring; most likely during the first few months of use |
| Progestin-only birth control |
| Depot medroxyprogesterone acetate (Depo-Provera®) |
| Progestin-only pills also called mini-pills – VERY unforgiving of missed pills |
| Progestin-containing intrauterine device–Mirena® |
| Hormone therapy for menopausal symptoms |
| Medical Illness |
| Adrenal disease |
| Adrenal hyperplasia |
| Cushing syndrome and disease |
| Clotting (coagulation) problems |
| Idiopathic thrombocytopenic purpura |
| Cancer, such as leukemia |
| Von Willebrand disease |
| Kidney (renal) disease |
| Liver disease |
| Pituitary disease |
| Thyroid disease |
| Medications/Drugs |
| Anticoagulants |
| Antipsychotic drugs |
| Progesterone |
| Tamoxifen |
| Complementary and Alternative Medicines (evidence may be sparse) |
| Chasteberry |
| Feverfew |
| Menopause (average age 51, defined as no bleeding for 1 year) |
| Ovarian Conditions |
| Ovarian cancers |
| Ovarian cysts |
| Ovarian tumors |
| Pregnancy |
| Conditions in Early Pregnancy |
| Miscarriage (medical term is spontaneous abortion) |
| Threatened |
| Incomplete |
| Complete |
| Tubal (ectopic pregnancy) |
| Molar pregnancy |
| Conditions in Late Pregnancy |
| Placental abruption |
| Placenta previa |
| Trauma |
| Foreign body in vagina |
| Retained tampon |
| Other objects |
| Sexual assault or abuse |
| Uterine Conditions |
| Pelvic inflammatory disease |
| Uterine fibroids (leiomyoma) |
| Vaginal Conditions |
| Vaginal infection (vaginitis) |
| Yeast infection (candidiasis) |
| Vaginal cancer |
| Vulvar Conditions |
| Lichen sclerosus |
| Rashes, other |
| Vulvar cancer |
| Sexually Transmitted Diseases |
| Chlamydia |
| Genital warts (condyloma), human papillomavirusGonorrhea |
| Trichomonas |
| Herpes simplex virus |