Abnormal Uterine Bleeding
Women start to have menstrual cycles from the age of 11-12 years to about 50 years. In this time span of 40 years one is likely to have few episodes of bleeding which is not her usual cycle.
If his abnormality persists then one needs to become concerned and consult a gynecologist. Abnormality can be -increase in the number of days of bleeding, more amount of bleeding, irregular bleeding, presence of clots or associated pain.
It is normal for a woman’s menstrual bleeding to last up to 7 days. Abnormal bleeding can occur when the menstrual period is not regular, when bleeding lasts longer than normal, is heavier than normal, or when bleeding patterns change.
What is a normal menstrual cycle?
A normal cycle that comes every 28-35 days lasts for 5-7 days and is not associated with pain or clots. During the menstrual cycle, two hormones -estrogen and progesterone act on the lining (endometrium) of the uterus and causes it to grow. At the end of the cycle this endometrium sheds as menstrual bleeding.
The menstrual cycle begins with the first day of the bleeding (referred as D1) and ends with the first day of the next period. An average cycle lasts about 28 days, but it can be longer or shorter. If the cycle is longer than 35 days or shorter than 21 days, it is considered abnormal. Abnormal uterine bleeding includes:
- Bleeding between periods
- Bleeding after sex
- Spotting anytime in the menstrual cycle
- Bleeding heavier or longer than normal
- Absence of menstrual periods for 3 normal cycles or 6 months
Abnormal bleeding can occur at any age. Irregular cycles are seen commonly during adolescence or close to menopause. Any change that is out of the ordinary should warrant a doctor's opinion.
Causes
Abnormal bleeding can be due to abnormal hormonal changes or due to pathology in uterus or ovaries. Some of these problems are not serious and can be easily treated by counselling or medications. Others can be more serious. All should be checked. Pregnancy related causes are also responsible for abnormal bleeding. Sometimes tumours in the uterus or even cancer can be the reason.
Diagnosis
To diagnose the cause for abnormal bleeding, a detailed history with physical examination is essential. Additionally few blood tests and an ultrasound examination may be needed to rule out various problems. It is helpful to maintain a menstrual calendar because it gives a good insight into the problem if the pattern is available over 4-6 months. Abnormality in thyroid hormone secretion can be a cause for abnormal bleeding hence thyroid test should be done. Beyond this hysteroscopy (endoscopic evaluation) of the uterine cavity or a D&C may be needed to reach to a diagnosis. Sometimes a laparoscopy is needed to rule out other causes.
Treatment
Treatment for abnormal bleeding will depend on many factors, including the cause, age, the severity of the bleeding, and whether one desires to have any future pregnancies. It can be treated with hormones or other medications, or surgery may be needed. It takes a few cycles to understand if the medications are working. First line of treatment is non-hormonal medications that help to reduce pain and bleeding when taken during the periods. If it helps you may need to take them during periods for few cycles. Hormones are other medications that maybe needed if there is suggestion of hormonal imbalance of deficiency. Progesterone (one type of hormone) can help prevent and treat endometrial hyperplasia. It may take a few months for hormones to control the bleeding. Your periods may be heavier for the first few months. However, they will lighten over time.
Surgery
Some women with abnormal uterine bleeding may need to have surgery to remove growths (such as polyps or fibroids) that are causing the bleeding. This often can be done with hysteroscopy or laparoscopy. An endometrial biopsy maybe needed to rule out endometrial cancer or hyperplasia. Hysterectomy-removal of the uterus is another procedure that may be used to treat abnormal bleeding. This may be done when other forms of treatments have failed or are not an option. Hysterectomy is major surgery. After this procedure, a woman will no longer have periods. She also will not be able to get pregnant.
Finally...
If you notice that your cycles have become irregular, it is better to consult a gynecologist. Abnormal bleeding has a number of causes. There is no way of telling why your bleeding is abnormal until a gynecologist has made an assessment of your problems. Once the cause is found, abnormal bleeding often can be treated with success.