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Endometrial causes

Some people have heavy periods with regular ovulation and no fibroids, polyps, or bleeding disorder. The cause lies in how the uterine lining itself controls bleeding.

By the AUB editorial teamUpdated September 2026PALM-COEIN: AUB-E

What is happening

The lining normally limits bleeding through a balance of local signals that promote clotting, constrict blood vessels, and repair tissue. In AUB-E, that local balance is disrupted, so periods are heavier than they should be even though the cycle is normal. Chronic inflammation of the lining (endometritis) can play a role in some people.

How it is diagnosed

AUB-E is a diagnosis of exclusion. It is made after pregnancy, structural causes, bleeding disorders, ovulatory problems, and medications have been ruled out.

Treatment

  • The levonorgestrel IUD
  • Tranexamic acid or NSAIDs during your period
  • Combined hormonal birth control or progestins
  • Endometrial ablation for people who have finished childbearing

Sources

  1. Munro MG, Critchley HOD, Fraser IS; FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393–408.

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