How to manage your abnormal bleeding
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Abnormal uterine bleeding is one of the most common reasons women see their doctors. It can occur at any age and has many causes. Some are easily treated, while others are more serious. Finding the cause is the first step in treatment.
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During the menstrual cycle, two hormones, called estrogen and progesterone, are made by the ovaries. Each month, these hormones cause the endometrium (lining of the womb) to grow in preparation for a possible pregnancy. About 12–14 days before the start of the period, an egg is released from one of the ovaries. This is called ovulation. The egg then moves into one of the fallopian tubes. There it can be fertilized by a sperm. If it is not, pregnancy does not occur. The levels of hormones decrease. This decrease is a signal for the uterus to shed its lining. This shedding is the menstrual period.
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The cycle begins with the first day of bleeding of one period and ends with the first day of the next. In most women, this cycle lasts about 28 days. Cycles that are shorter or longer by up to 7 days are normal. For most women, the period lasts for 4-7 days.
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What would be considered “abnormal bleeding”?
Bleeding in any of the following situations is abnormal:
Bleeding between periods
Bleeding after sex
Spotting anytime in the menstrual cycle
Bleeding heavier or for more days than normal
Bleeding after menopause
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Menstrual cycles that are longer than 35 days or shorter than 21 days are abnormal. The lack of periods for 3–6 months (amenorrhea) is not normal and should be evaluated by your doctor.
Abnormal bleeding can occur at any age. At certain times in a woman's life it is common for periods to be somewhat irregular. They may not occur on schedule in the first few years after a girl starts to have them (around age 9–16 years). The cycle may get shorter near age 35 years. It often gets shorter as a woman nears menopause (around age 50 years). It also is normal then to skip periods or for bleeding to get lighter or heavier.
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What are potential causes of abnormal bleeding?
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Abnormal bleeding can have many causes. Your doctor may start by checking for problems most common in your age group. Some of them are not serious and are easy to treat. Others can be more serious. All should be checked. In some women, too much or not enough of a certain hormone can cause abnormal or heavy bleeding. This imbalance can be caused by many things, such as thyroid problems or some medications.
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Other causes of abnormal uterine bleeding include:
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| pregnancy
miscarriage
ectopic pregnancy
problems linked to some birth control methods
(such as an intrauterine device or birth control pills)
infection of the uterus or cervix
fibroids, polyps or ovarian cysts
problems with blood clotting
chronic medical conditions
(for instance, thyroid problems and diabetes)
certain types of cancers
(particularly cancer of the uterus, cervix, or vagina)
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To find the cause, your doctor will ask about your personal and family health history. You may be asked about these issues:
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- Your medical history (past or present illnesses)
- Use of medications
- Use of birth control
- Weight, eating and exercise habits, and level of stress
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Your doctor also will ask about your menstrual cycle. You can help by keeping track of it before your visit. Note the dates, length, and type (light, medium, heavy, or spotting) of your bleeding on a calendar (“Menstrual Flow Diary”). Your doctor can use your notes to help pinpoint the problem.
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□ Pelvic ultrasound
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Sound waves are used to make a picture of the pelvic organs.
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□ Endometrial biopsy
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Using a small catheter (or tube), a tissue sample is taken from the uterine lining and looked at under a microscope. This test will evaluate for any cancerous or precancerous changes of the uterus.
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□ Hysterosonogram
(Saline Infusion Sonogram)
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Sterile saline (salt water) is placed in the uterus through a thin tube, while ultrasound images are made of the uterus. This can evaluate for the presence of endometrial polyps or fibroids that may be located in the uterine cavity.
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□ Hysterosalpingography
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Dye is injected into the uterus and fallopian tubes as an X-ray is taken. This test evaluates both the inside of the uterus for the presence of endometrial polyps or fibroids and also checks if the fallopian tubes are open. This test is more commonly performed as part of a fertility work-up
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□ Hysteroscopy
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A thin device with a camera is inserted through the vagina and into the uterus to let the doctor view the inside of the uterus. Endometrial polyps or fibroids may be identified with this procedure and often they can be removed at the same time
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□ Dilation & curettage
(D&C)
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The opening of the cervix is enlarged. Tissue is gently scraped or suctioned from the lining of the uterus. It is examined under a microscope.
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□ Laparoscopy
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This procedure is performed in an operating room under general anesthesia. A thin device (like a telescope) is inserted through a small cut just below or through the navel. Your doctor cen then view inside of the abdomen. Diagnostic laparoscopy is simply observing or looking at all the organs in the pelvis (as well as upper abdomen). Procedures such as biopsies or removal of ovarian cysts and even the uterus can also be performed and this is referred to as Operative Laparoscopy.
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Observation
Once a diagnosis has been made, treatment options can be discussed. The two most important causes of abnormal bleeding, abnormal bleeding in pregnancy and cancer, need to be ruled out or treated accordingly. Treatment will depend on many factors, including the cause of bleeding. Your age and whether you want to have children also play a role. Treatment falls into three categories. The first is observation. You will be asked to monitor your symptoms. If symptoms interfere with your day-to-day activities you may consider medical treatment or surgical treatment.
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