Abnormal Menstrual Bleeding

What is a Normal Menstrual Cycle?

The normal length of the menstrual cycle is typically between 21 and 35 days. A normal menstrual period usually lasts up to 7 days

When Is Bleeding Abnormal?

Bleeding that occurs in any of the following situations is considered abnormal uterine bleeding:

Bleeding or spotting between menstrual periods
Relationship bleeding or spotting after
Heavy bleeding during your period
Bleeding through one or more tampons or pads every hour
Bleeding that lasts more than 7 days
Menstrual cycles longer than 35 days or less than 21 days
“Irregular” periods where the cycle length varies by more than 7 to 9 days
Absence of menstruation for 3 to 6 months
Bleeding after menopause

What is the Difference Between Chronic and Acute Abnormal Uterine Bleeding?

Abnormal uterine bleeding can be a chronic condition, which means that abnormal bleeding has occurred frequently for at least the past 6 months. Sudden, unusual episodes of abnormal bleeding may also occur, which is called acute abnormal uterine bleeding. If you are changing pads or tampons every hour for more than 2 consecutive hours and also have chest pain, shortness of breath, dizziness or lightheadedness, seek emergency medical attention immediately.

At What Ages Are Abnormal Bleeding More Common?

Abnormal bleeding can occur at any age. But it's common for menstrual periods to be somewhat irregular at certain times in a woman's life:

When girls first start menstruating (between the ages of 9 and 14), their menstrual periods may not occur regularly.
During perimenopause (around age 50), the number of days between menstrual periods may change. It is common for menstrual periods to be skipped or for bleeding to become lighter or heavier during this period.

What Causes Abnormal Bleeding?

Some of the causes of abnormal bleeding include:

Ovulation problems: Lack of ovulation can cause irregular, sometimes heavy menstrual bleeding. If you don't ovulate for several menstrual cycles, areas of the endometrium (the tissue lining the uterus) can become very thick. This can occur in the first few years after menstruation begins and during perimenopause. It can also occur in women with certain medical conditions, such as polycystic ovary syndrome (PCOS) and hypothyroidism.
Fibroids and polyps — Fibroids are noncancerous growths formed from uterine muscle tissue. Polyps are another type of non-cancerous growth. They can be found inside the uterus or in the cervix. Both can cause irregular or heavy menstrual bleeding.
Adenomyosis — In this condition, the endometrium grows into the uterine wall. Signs and symptoms may include heavy menstrual bleeding and menstrual pain that worsens with age.
Bleeding disorders: When a woman's blood does not clot properly, heavy bleeding may occur. If you have heavy periods since the moment you started menstruating You may have a bleeding disorder. Other symptoms include heavy bleeding after birth or during surgery, bleeding gums after dental surgery, easy bruising, and frequent nosebleeds.
Medications: Hormonal birth control methods may cause changes in bleeding, including breakthrough bleeding (bleeding at a time other than your menstrual period). Some medications, such as blood thinners and aspirin, can cause heavy menstrual bleeding. Copper intrauterine device (IUD) may cause heavy menstrual bleeding, especially in the first year of use.
Cancer: Abnormal uterine bleeding may be an early sign of endometrial cancer. Most cases of endometrial cancer occur in women who are past menopause, in their mid-60s. It is usually diagnosed at an early stage when treatment is most effective. A condition that can lead to endometrial cancer is endometrial intraepithelial neoplasia is called . It also causes abnormal uterine bleeding. Treatment of this condition may prevent endometrial cancer.
Other causes: Endometriosis and other problems with the endometrium can cause heavy menstrual bleeding. Other causes of abnormal uterine bleeding include those related to pregnancy, such as ectopic pregnancy and miscarriage. Pelvic inflammatory disease (PID) may also be a cause. Sometimes there is more than one reason.

How is Abnormal Bleeding Diagnosed?

Your obstetrician should be asked about personal and family health history, such as past and present illnesses and surgical procedures, pregnancy history, medications, including those purchased without a prescription, and birth control method.

Information about when bleeding occurs and the amount of bleeding is also helpful. It is helpful to note the date, length, and type of bleeding (light, moderate, heavy, or spotting) on a calendar. She may also use a smartphone app designed to track menstrual cycles.

If you have acute, heavy bleeding, treatment should be started immediately to control it. If there is a lot of blood loss, fluids or a blood transfusion may be necessary. After the condition stabilizes, the gynecologist will begin to look for the cause of the bleeding.

What Tests and Examinations May Be Required to Diagnose the Cause of Abnormal Bleeding?

A physical examination should be performed, including a pelvic examination. Some Laboratory tests can be done. A blood test called a complete blood count (CBC) can help determine if anemia or infection is present. Tests may be performed for some bleeding disorders. You can get a pregnancy test and tests for sexually transmitted infections.

Depending on symptoms and age, other tests may be necessary:

Ultrasound examination — Sound waves are used to view the pelvic organs.
Hysteroscopy — A thin, lighted microscope is inserted through the vagina and cervix. It allows the gynecologist to see the inside of the uterus.
Endometrial biopsy — A sample of the endometrium is taken and examined under a microscope.
Sonohysterography — It is a procedure performed by injecting fluid into the uterus through a thin tube while ultrasound images of the uterus are taken.
Magnetic resonance imaging (MRI) —This imaging test uses powerful magnets to create images of internal organs.
Computed tomography (CT)—This x-ray procedure shows internal organs and structures in cross-section.

What Medications Are Used to Control Abnormal Bleeding?

Medications are often tried first to treat irregular or heavy menstrual bleeding. Some of these drugs also prevent pregnancy. This may be useful if you need a birth control method. Medicines that may be used include:

Hormonal birth control methods: Irregular bleeding and heavy bleeding caused by ovulation, PCOS, and fibroid problems can often be managed with certain hormonal birth control methods.
- Combined oral contraceptives, hormonal intrauterine devices, and Subcutaneous implants contain hormones. They can ease menstrual flow and help make menstrual periods more regular. With long-term use, it may reduce the number of your menstrual periods or stop them completely.
- Progestin-only hormonal methods, such as hormonal IUDs, pills, and injections, may also reduce bleeding. IUD and injection can completely stop bleeding after 1 year of use.
Hormone therapy may be helpful for heavy menstrual bleeding that occurs during perimenopause and can treat other perimenopausal symptoms such as hot flashes, night sweats, and vaginal dryness. Perimenopausal women can also use the hormonal birth control methods discussed above. You may still have menstrual periods while taking hormone therapy, but they are usually lighter and more predictable in time and duration. Hormone therapy There are risks such as increased risk of heart attack, stroke and cancer. Before deciding to use hormone therapy It is important to weigh the benefits and risks based on personal and family medical history.
Gonadotropin-releasing hormone (GnRH) agonists—These medications can stop the menstrual cycle and reduce the size of fibroids. They are only used for short periods of time (less than 6 months). Its effect on myomas is temporary. When you stop taking the medication, fibroids usually return to their original size.
Tranexamic acid — This prescription medication treats heavy menstrual bleeding.
Nonsteroidal anti-inflammatory drugs (NSAIDs) — Containing active ingredients like ibuprofen, these medications can also help control heavy bleeding and relieve menstrual cramps.
If you have a bleeding disorder, treatment may include medications to help blood clot.
If there is infection, antibiotics may be given.

What Type of Surgeries Are Performed to Treat Abnormal Bleeding?

If medication cannot control bleeding, a surgical procedure may be needed. There are different types of surgery depending on the general condition, age and desire to become pregnant in the future.

Endometrial ablation destroys the lining of the uterus. It stops or reduces the total amount of bleeding. Pregnancy is unlikely after ablation, but it can still happen. If this procedure is performed and children are not desired, birth control will be required until after menopause. Sterilization (permanent birth control) may be a good option to prevent pregnancy for women who undergo ablation. Another risk is that it may be more difficult to detect endometrial cancer after ablation.
Myoma treatments that protect the uterus:
- Uterine artery embolization: Blood vessels in the uterus are blocked and blood flow is stopped, allowing fibroids to grow.
- MRI-guided ultrasound surgery: Ultrasound waves are used to destroy fibroids.
- Myomectomy: In this surgery, only myomas are removed, not the uterus. One disadvantage is that fibroids may grow back after this surgery.
Hysterectomy is the removal of the uterus. This surgery is used to treat fibroids and adenomyosis when other types of treatment have failed or there are no other options. It is also used in the treatment of endometrial cancer. Hysterectomy can be done in different ways: through the vagina, through the abdomen, or by laparoscopy. After the uterus is removed, the woman can no longer get pregnant or menstruate.