Abnormal bleeding in women is vaginal bleeding that’s not related to regular menstruation. The duration of a normal menstrual cycle is between 21 and 35 days, with bleeding occurring once each cycle when the uterus sheds its lining. Any bleeding outside of the normal frequency and amount associated with menstruation is considered abnormal.
Menorrhagia or hypermenorrhea are the medical terms for excessive or prolonged menstrual bleeding. Many women experience abnormal vaginal bleeding or spotting between periods sometime in their lives. Vaginal bleeding is considered to be abnormal if it occurs:
- When you are not expecting your menstrual period.
- When your menstrual flow is lighter or heavier than what is normal for you.
- At a time in life when it is not expected, such as before age 9, when you are pregnant, or after menopause.
Abnormal vaginal bleeding has many possible causes, but doesn’t always indicate a serious condition.
- Because bleeding can mean a problem with pregnancy, possible pregnancy should always be considered in a woman of childbearing age.
- Spotting to minimal bleeding may be normal, but any bleeding during pregnancy should be evaluated by your healthcare provider.
- Heavy vaginal bleeding or bleeding that occurs before 12 weeks in the pregnancy may indicate a serious problem, including an ectopic pregnancy or possible miscarriage.
- Heavy vaginal bleeding or bleeding that occurs after 12 weeks in the pregnancy may also indicate a serious problem, such as placenta previa.
- Ovulation can cause mid-cycle bleeding.
- Polycystic ovary syndrome (PCOS) is a hormone imbalance that interferes with normal ovulation and can cause abnormal bleeding.
- Medicines, such as birth control pills, sometimes cause abnormal vaginal bleeding, causing minor bleeding between periods during the first few months if you have recently started using birth control pills. You also may have bleeding if you do not take your pills at a regular time each day.
- An intrauterine device (IUD) also may increase your chances of spotting or heavy periods.
- Infection of the pelvic organs (vagina, cervix, uterus, fallopian tubes, or ovaries) may cause vaginal bleeding, especially after intercourse or douching. Sexually transmitted infections (STIs) are often the cause of infections.
- Pelvic inflammatory disease (PID) causes inflammation or infection of the uterus, fallopian tubes, or ovaries, which can cause abnormal bleeding.
Other less common causes of abnormal vaginal bleeding that may be more serious include:
- Sexual abuse.
- An object in the vagina.
- Uterine fibroids, which are a common cause of heavy periods.
- Structural problems, such as urethral prolapse or polyps.
- Cancer of the cervix, uterus, ovaries, or vagina.
- Extreme emotional stress and excessive exercise. But excessive exercise more frequently causes an absence of menstruation (amenorrhea).
- Other diseases, such as hyperthyroidism or diabetes.
Heavy bleeding during the first few weeks after delivery (postpartum) or after an abortion may occur because the uterus has not contracted to the pre-pregnancy size or because fetal tissue remains in the uterus (retained products of conception).
If you are age 40 or older, abnormal vaginal bleeding may mean that you are entering perimenopause. In a woman who has not had a menstrual period for 12 months, vaginal bleeding is always abnormal and should be discussed with your doctor.
The treatment that you receive depends on many factors, including the cause and the extent of your condition. Your healthcare provider may recommend iron supplements and non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen, aspirin, or naproxen act as prostaglandin inhibitors and can relieve symptoms. Birth control pills or the hormone progesterone may also be used to reduce menorrhagia.
Surgery may be needed if drug therapy fails or if there is an underlying condition that needs to be treated. There are several surgical options that you show;d discuss with your provider. The type of treatment that you receive may depend on the type of condition that you actually have. It is important that you understand the long-term consequences of the procedures before you make a decision. Your doctor can provide you with a thorough explanation of all of your options to help you decide what is best for you. Common surgical procedures for menorrhagia include dilation and cutterage (D&C), operative hysteroscopy, endometrial ablation, endometrial resection, and hysterectomy.
A D&C is a common procedure used to reduce menstrual bleeding. A surgeon can use a suction or scrape method to remove the lining of the uterus. The procedure may need to be repeated over time. An ultrasound may used to guide the surgeon to the exact area in question.
An operative hysteroscopy is used to view your uterine cavity and remove a polyp that may contribute to heavy bleeding. An operative hysteroscopy involves inserting a hystoscope into the uterus, through the vagina and dilated cervix. The hystoscope transmits images to a video system to guide your doctor during the procedure.
Endometrial ablation uses high energy to permanently destroy the lining of the uterus. Endometrial resection uses an electrosurgical wire loop to remove the uterine lining. These two options should be used by women who are certain that they do not want to have children.
A hysterectomy is a surgical procedure that removes the uterus and usually the cervix. A hysterectomy is permanent and non-reversible. After a hysterectomy, a woman will not have periods and will not be able to become pregnant.
As always, The Women’s Center believes in thoroughly explaining treatment options in regards to your health. We believe the relationships that we have with our patients makes this possible, and with in office procedures many of our procedures can be performed with safety, convenience and less expense for the patient. If you have any questions about these procedures or any of the others we provide our patients please call us at 407.857.2502, or contact us here. We’d love to speak to you and do our best to answer any questions concerns you might have.