You’ve never kept a written record of your menstrual cycles. 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, so you 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 more concerned if it is serious. You should learn more about abnormal uterine bleeding.
Understanding abnormal bleeding
Menstruation is cyclical bleeding that occurs every 25 to 30 days from the birth canal, called the vagina. It is the shedding of the lining of a non-pregnant womb and blood that occurs every month. This cyclical sequence that lasts through the childbearing years is delicately controlled by hormones. Conception or getting pregnant causes it to stop during the reproductive years, and the bleeding cycles return after childbirth.
An abnormal bleeding pattern includes bleeding that occurs in between periods, bleeding that is scantier than normal during periods, periods that last longer or bleed unusually more, bleeding that occurs after the permanent cessation of periods at the age of 45–50 years, and bleeding that occurs after sex. Some women may get spotting at varying times in between periods. Abnormal bleeding can occur at any age.
Causes
Abnormal uterine bleeding can be caused by an imbalance in the hormonal control that regulates the cyclical bleeding. It can be caused by problems in the sex gonads in women called ovaries, the womb called the uterus, the lower part of uterus called cervix, or the birth canal called the vagina. Anovulation, i.e., the absence of the production of an ovum or egg by the ovaries, causes disturbances in hormone secretion by the ovaries and causes abnormal bleeding. Bleeding that usually occurs after intercourse is usually caused by an infection, erosion, or cancer of the vagina or cervix. Another common cause of bleeding is polyps, an outgrowth from the innermost lining of the uterus called 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 (IUDs) inserted for birth control can also cause abnormal bleeding. In some cases, it may be caused by a blood clotting disorder or other medical conditions like problems with 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 abnormal bleeding, it is called dysfunctional uterine bleeding. This can be a sign of an approaching menopause.
Women in their 20s and 30s or younger
Young women in their teens can have abnormal bleeding, which is usual for the first few years after they start menstruating. It is during this time that the body fine-tunes its hormonal levels. This becomes regular and cyclical over time. Girls who have never had their first period can have a vaginal bleed due to trauma, sexual abuse, urinary tract or genital infection, or irritation due to soaps, lotions, foreign bodies, toys, or toilet tissues. Women who are on birth control pills can experience a breakthrough bleeding as there are some changes in the endometrium. It is normal when a pill is forgotten. Some women may not produce ovaries or may have abrupt hormonal changes when eggs are produced. This causes spotting or intermittent bleeding. Endometrial polyps or fibroids are other causes of bleeding in this age group. Medical conditions, blood clotting disorders, and inflammation of the endometrium can all cause abnormal bleeding. Women who get pregnant can experience spotting or frank bleeding. It can be due to hormonal disturbances, a weekly implanted baby, or a miscarriage.
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. The use of birth control pills can cause breakthrough bleeding. These women may get pregnant and may bleed due to hormonal changes that are more likely as age advances.
Women after menopause
Once the cycles have naturally ceased to occur, any bleeding occurring later in life is an alarm. The commonest cause in such elderly women is cancer of the uterus or another genital organ. It can be caused by a polyp, thickening, or fibroid in the endometrium. With ageing, the lining of the vagina or uterus may thin down to expose the blood vessels and cause them to bleed. This atrophy is common in menopausal women. Menopausal women may also bleed due to a hormonal imbalance caused by hormonal replacements that are usually prescribed for them. Infections, medical disorders, or blood-thinning medicines like aspirin can cause bleeding.
Diagnosis
This begins with a physical examination by the doctor, and you will be asked to maintain a diary to keep a close record of your bleeding. Blood tests for blood counts and hormonal levels are important. Based on the symptoms, you may need to undergo an ultrasound or an examination of the internal genital organs through an endoscope, a thin device that bears a camera and is inserted up through the vagina to view the reproductive tract. An endoscope may be inserted through a small cut around the navel. This is called laparoscopy and gives a view inside the abdomen. A segment of the lining of the uterus or other organs can be pinched off to be examined under a microscope for changes. This is called a biopsy. A dye may be injected into the uterus, and a series of X-rays may be taken. This is called hysterosalpingography.
Dilatation and curettage (D&C)
You may need to undergo dilatation and curettage (D&C). This is a procedure where a speculum is inserted in the vagina to view the cervix. Then, using small cylindrical rods, the cervix is dilated. When access is gained to the uterus, the innermost lining of the uterus is scraped off. The material is then subjected to a detailed examination under a microscope. This procedure helps in the diagnosis of the cause of the abnormal bleeding. It has the added advantage of being curative for some types of uterine bleeding. A new lining that builds up is then shed cyclically, and the erratic cycles are corrected.
Treatment
Treatment of 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. A cancer, polyp, or fibroid may need surgical removal or removal through an endoscope inserted through the vagina. Birth control pills, which are causative of abnormal bleeding, may help control some types of bleeding by restoring the delicate hormonal balance.
Take-home message
Abnormal bleeding is not uncommon. It should not be ignored. You should have yourself examined and investigated to determine the cause of any bleeding that is abnormal. Timely treatment can prevent many complications, like anaemia and weakness, and help you stay healthy.