Abnormal Uterine Bleeding
The Menstrual Cycle
Normal menstrual bleeding can be from 1 – 7 days. Abnormal bleeding can occur when the menstrual period is irregular, bleeding lasts longer than 7 days, or is heavier than normal.
Normally, estrogen and progesterone are hormones that are made by the ovaries. Ovulation occurs 12-14 days before the start of the new menstrual cycle. This is when the egg is released into the fallopian tubes. If the egg is not fertilized in the fallopian tube, then pregnancy does not occur and the hormone levels fall. With this decrease of hormones signals the uterus to shed its lining, the endometrium. This shedding is the monthly menstrual cycle.
By convention, the menstrual cycle begins with the first day of the bleeding of one period and ends with the first day of the next cycle. On average, a cycle lasts about 28 days. Normal cycles range anywhere form 21-28 days.
Abnormal uterine bleeding includes:
Abnormal bleeding can occur at any age. Periods can be irregular when a girl first starts her cycles (around the ages 9-16). Beginning as early as age 40, but more commonly around age 50, a woman nears menopause. It is normal for her cycles to change to shorter ones, skip periods, or have less bleeding. If her cycles become heavier, however, she should see her doctor.
Causes of Abnormal Bleeding
There are many causes, some of which are serious and others minor which can easily be treated. Once the cause is found, abnormal bleeding often can be treated with success. All should be evaluated.
Some causes include pregnancy, miscarriage, ectopic pregnancy, problems linked to some birth control methods like intrauterine device or oral contraceptive pills, infections of the uterus or cervix, benign fibroid tumors, clotting disorders, polyps, cancer of the uterus, cervix, or vagina, thyroid problems, or hormonal fluctuations.
It is important for your doctor to be familiar with your personal and family health history which would include your past or present illnesses, use of medications or herbs, weight, eating and exercise and levels of stress.
It is important to keep track of your menstrual cycles with a menstrual diary which your doctor can review quickly.
Your doctor will usually give you a physical exam and possibly check some blood tests or a pregnancy test. Most of the below tests can be done in the office, but other’s must be done at the hospital or another facility. Sometimes, your doctor will recommend the following tests:
Endometrial biopsy- Using a small catheter (straw) a small amount of the lining of the uterus is gently scraped to determine the reason of bleeding. The sample is sent to the pathologist to read under the microscope.
Ultrasound-Sound waves are used to create a picture of the uterus and ovaries. The ultrasound can be placed on the abdomen or in the vagina. The transvaginal ultrasound often allows clearer pictures of the uterus because the probe is closest to the uterus.
Sonohysterography - Fluid is placed into the uterus through a thin catheter. Sound waves again are used to create pictures not only of the uterus, but this method of ultrasound can also help evaluate the inside of the uterus.
Hysterosalpingography -Dye is injected into the uterus and fallopian tubes for an x-ray test. This test is particularly helpful for evaluating that the fallopian tubes are open and not scarred in cases of infertility.
Hysteroscopy - A thin telescope-like device with a camera is inserted through the vagina and into the cervix to view the inside of the uterus.
Dilation and curettage (D&C) - The opening of the cervix is enlarged. The tissue is gently scraped or suctioned from the lining of the uterus. The tissue sample is then examined under the microscope looking for any abnormal cells like hyperplasia (pre-cancerous) or cancer cells.
Laparoscopy - A slender telescope-like device with a camera is inserted through a cut in the navel to view the inside of the abdomen.
Treatment for abnormal bleeding will depend on many factors, including the cause, your age, the severity of the bleeding, and whether you want to have children. You may be given hormones, birth control pills, or other medications, or need surgery. After a few menstrual cycles, your doctor should be able to judge how well the treatment is working. If you think that you might be pregnant, let your doctor know prior to starting any therapy.
Some women will need surgery to treat abnormal uterine bleeding.
Hysteroscopy/ Dilation and curettage/ Polyp removal - If growths such as polyps or uterine fibroids are causing the abnormal bleeding, you may have this procedure combination at first to evaluate the uterine cavity followed by removal of the polyp or fibroid.
Endometrial ablation is used to treat abnormal bleeding. This treatment can use electricity, laser, heat or freezing to destroy the lining of the uterus. It is intended to stop or reduce bleeding permanently. An endometrial biopsy is needed prior to treatment. A woman should be done with having children when she elects to have this procedure done.
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. Although hysterectomy is a major surgery, it, however is definitive treatment for abnormal bleeding. After the process, a woman will no longer have periods nor be able to have children.
Before you decide on treatment, think and discuss all your options with your doctor.