Understanding abnormal uterine bleeding and fertility | Progyny

Updated by the Progyny Editorial Team — September 2025.

Abnormal uterine bleeding (AUB) is a common but often distressing condition that can affect your daily life — especially if you are trying to conceive. We spoke with Dr. Nicole Marchetto, a reproductive endocrinologist at Shady Grove Fertility in Pennsylvania and Delaware, to better understand how AUB may affect fertility and what treatment options can help.

What is AUB?

Normally, your period comes every 21 to 35 days and lasts about two to seven days. AUB is when bleeding doesn’t follow that pattern. This can include:

• Heavy bleeding that interferes with daily activities
• Bleeding between periods
• Periods that come less than 21 days apart
• Periods that are more than 35 days apart
• No periods for three or more months

What are the causes of AUB?

The causes can be either structural or non-structural.

Structural causes may include:

• Polyps: benign growths on the inner lining of the uterus or cervix
• Adenomyosis: uterine lining that grows into the muscle wall
• Fibroids: non-cancerous tumors within the uterine wall
• Cancer or precancerous conditions in the uterus

Non-structural causes may include:

• Blood clotting disorders
• Hormonal imbalances that affect ovulation
• Changes within the lining of the uterus
• Certain medications that trigger abnormal bleeding
• Other underlying health issues

How does AUB affect fertility?

When your cycle is irregular or absent, it can be harder to know when you are ovulating, which makes it more difficult to time conception.

Growths in the uterus, such as fibroids or polyps, can sometimes make it harder for an embryo to attach to the uterine lining. They may also raise the chance of miscarriage.

Together, these challenges can complicate your efforts to conceive.

How is it diagnosed?

Diagnosis usually starts with your medical history and a physical exam. Your healthcare provider may also recommend:

• Bloodwork to check hormone levels, thyroid function, and clotting factors
• Imaging tests such as ultrasound, hysteroscopy, or MRI to look for uterine changes
• An endometrial biopsy to rule out cancer or precancerous cells

What are the treatment options?

Treatment depends on the cause, your symptoms, and your fertility goals. Options may include:

Medications

• Hormonal therapy, such as birth control pills, progesterone, or hormone-releasing intrauterine devices, to regulate cycles and reduce bleeding
• Non-hormonal options, such as NSAIDs or tranexamic acid, to manage bleeding
• Treatment of underlying issues, such as thyroid conditions or clotting disorders

Procedures

• Hysteroscopy: a minimally invasive surgery to remove polyps or small fibroids
• Endometrial ablation: removing or destroying the uterine lining to reduce bleeding (not recommended for those who wish to conceive)
• Myomectomy: surgical removal of fibroids while preserving the uterus
• Hysterectomy: removal of the uterus, generally a last resort and not an option if you want to maintain fertility

Key takeaway

AUB is complex, but it is treatable. If you are experiencing unusual bleeding, early diagnosis and care can help manage symptoms and improve your chances of conceiving. Talk with your provider if you notice changes in your cycle so you can explore the best treatment options for your fertility and overall health.

If you have questions or concerns, Progyny is here for you. Please contact your Progyny Care Advocate for support.

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.