You have never kept a written record of your periods. This month when you had one, you felt that it happened before it was anticipated. You were too busy to recollect when you last had a period and ignored it. But the bleeding did not cease until 3 or 5 days. You are now anxious. You do not know why it is occurring or what you have to do. You are even concerned if it is serious. You should learn more about abnormal uterine bleeding.
Understanding abnormal uterine bleeding
Menstruation is a cyclical bleeding that occurs every 25 to 30 days from the birth canal called vagina. It is the shedding of the lining of a non pregnant womb and blood that occurs every month. This cyclical sequence that lasts the childbearing years is delicately controlled by hormones. A conception or getting pregnant causes it to stop during the reproductive years, and the bleeding cycles return after childbirth.
An abnormal bleeding includes bleeding that occurs in between the periods, bleeding scantier than normal during periods, periods that last longer or bleed unusually more, bleeding that occurs after the permanent cessation of periods at age of 45-50 years, and bleeding that occurs after sex. Some women may get spotting at varying times in between the periods. Abnormal bleeding can occur at any age.
Causes
Abnormal uterine bleeding can be caused by imbalance in the hormonal control that regulates the cyclical bleeding. It can be caused by problems in the sex gonads (ovaries), the womb (uterus), the lower part of uterus (cervix), or the birth canal (vagina). Anovulation, i.e., absence of production of ovum or egg by the ovaries results in disruption of hormone secretion and abnormal bleeding. A bleeding that usually occurs after intercourse is caused by an infection, erosion, or cancer of the vagina or cervix. Another common cause for bleeding is polyp, an outgrowth from the innermost lining of the uterus (endometrium). It can be a sign of cancer of the endometrium or small or large non-cancerous masses called fibroids that develop in the endometrium.
Bleeding in pregnancy is alarming and can be a sign of miscarriage or an ectopic pregnancy, a condition where the growing baby erroneously implants at a site other than the uterus. Pills and intrauterine devices (IUD) inserted for birth control can also cause abnormal bleeding. In some, it may be caused by a blood clotting disorder or other medical conditions like problem of the thyroid gland, liver, or diabetes. The cause and nature of bleeding vary among women in different age groups. A stressful event or lack of physical exercise can also lead to abnormal menstrual cycles.
When no local or general causes can be determined for an abnormal bleeding, it is called a dysfunctional uterine bleeding. This can be a sign of an approaching menopause.
Women in their 20s and 30s or younger
Abnormal bleeding is the most common type of bleeding in women in their teens. It is normal for the first couple of years after the start of menstruation. During this period, the body fine-tunes the hormone levels. Over time, the menstrual cycle becomes regular and circular. Girls who never got their first period may experience vaginal bleeding as a result of trauma, sexual assault, urinary tract infection, or irritation caused by soap, lotion, foreign body, toys, toilet tissue, etc. Women who take birth control pills may experience breakthrough bleeding. It is normal when they forget to take a pill. In some women, abnormal bleeding may be caused by some hormonal disturbances. They may not produce ovum or have sudden hormonal changes when they produce an egg. This can lead to spotting or irregular bleeding. Other causes of abnormal bleeding in women of this age group include medical conditions, blood clots in the ovaries, inflammation of the lining of the uterus, endometrium polyps, or endometrial fibroids. If a woman gets pregnant, she may experience spotting and frank bleeding.
Women in their 40s and early 50s
Abnormal bleeding is common in perimenopause, a phase of transition from reproductive years to complete cessation of menstruation called menopause. Inconsistent ovulation in this period can cause a hormonal imbalance that causes the endometrium to thicken and produce outgrowths that can bleed. Cancer, infection, or other medical conditions like a deficit in thyroid function can also cause abnormal bleeding. Use of birth control pills can cause a breakthrough bleeding. These women may get pregnant and may bleed due to the hormonal changes that are more likely as age advances.
Women after menopause
Once the natural cycle of menstruation has ceased, any bleeding that occurs later in life should be a cause for concern. The most frequent cause of bleeding in elderly women is uterine cancer. This can be due to polyps, thickening, or fibroid in the endometrium. As women grow older, the vaginal or uterine lining may become thinner exposing the blood vessels and cause them to bleed. This is a common occurrence in menopausal females. Additionally, menopausal women may experience bleeding due to hormonal imbalances caused by prescribed hormonal replacements. Bleeding can also be caused by infections, medical conditions, and blood thinning medications.
Diagnosis
A physical examination must be conducted by a medical professional and maintain a diary keeping a detailed record of the bleeding. Blood counts and hormone levels must be monitored. Depending on the signs and symptoms, an ultrasound may be conducted or an endoscope is inserted through the vagina to examine the reproductive tract. Uterine tissue samples may be examined under a microscope. Hysterosalpingography involves the injection of a dye into the uterus, followed by a sequence of X-rays.
D&C (dilation and curettage)
A D&C (dilation and curettage) procedure involves inserting a speculum into the vagina to examine the cervix. Small cylindrical rods are used to dilate the cervix. When access to the uterus is gained, the innermost layer of the uterine lining is scraped off and examined under a microscope. This procedure helps in diagnosis of the cause of the abnormal bleeding and has the additional benefit of being a curative measure in certain types of uterine bleeding. A new lining that builds up is then shed cyclically and the erratic cycles are corrected.
Treatment
Treatment of an abnormal bleeding depends on the cause. Hormones like progestin or hormone loaded intrauterine devices help to correct the imbalance if there is one. If there is an infection, it needs to be treated with medicines called antibiotics. Make sure you take all your medicines as directed by your doctor. Cancers, polyps, and fibroids may require surgical interventions. In some cases, hormonal contraceptives, such as birth control pills, which are known to cause abnormal bleeding, may help control some types of bleeding by restoring the hormonal balance.
Take home message
Abnormal bleeding is not a common occurrence and should not be disregarded. It is recommended that you have yourself medically examined and evaluated to identify the underlying cause of any abnormal bleeding. Prompt treatment can avert a variety of complications, such as anemia and weakness, and aid in maintaining a healthy lifestyle.
