Abnormal uterine bleeding is one of the most common reasons women see their doctors. It can occur at any age and has many causes. Some are easily treated, while others are more serious. Finding the cause is the first step in treatment.
The Menstrual Cycle
During the menstrual cycle, two hormones, called estrogen and progesterone, are made by the ovaries. Each month, these hormones cause the endometrium (lining of the womb) to grow in preparation for a possible pregnancy. About 12–14 days before the start of the period, an egg is released from one of the ovaries. This is called ovulation. The egg then moves into one of the fallopian tubes. There it can be fertilized by a sperm. If it is not, pregnancy does not occur. The levels of hormones decrease. This decrease is a signal for the uterus to shed its lining. This shedding is the menstrual period.
The cycle begins with the first day of bleeding of one period and ends with the first day of the next. In most women, this cycle lasts about 28 days. Cycles that are shorter or longer by up to 7 days are normal.For most women, the period lasts for 4-7 days.
What would be considered “abnormal bleeding”?
Bleeding in any of the following situations is abnormal: Bleeding between periods Bleeding after sex Spotting anytime in the menstrual cycle Bleeding heavier or for more days than normal Bleeding after menopause
Menstrual cycles that are longer than 35 days or shorter than 21 days are abnormal. The lack of periods for 3–6 months (amenorrhea) is not normal and should be evaluated by your doctor.
Abnormal bleeding can occur at any age. At certain times in a woman's life it is common for periods to be somewhat irregular. They may not occur on schedule in the first few years after a girl starts to have them (around age 9–16 years). The cycle may get shorter near age 35 years. It often gets shorter as a woman nears menopause (around age 50 years). It also is normal then to skip periods or for bleeding to get lighter or heavier.
What are potential causes of abnormal bleeding?
Abnormal bleeding can have many causes. Your doctor may start by checking for problems most common in your age group. Some of them are not serious and are easy to treat. Others can be more serious. All should be checked. In some women, too much or not enough of a certain hormone can cause abnormal or heavy bleeding. This imbalance can be caused by many things, such as thyroid problems or some medications.
Other causes of abnormal uterine bleeding include:
pregnancy miscarriage ectopic pregnancy problems linked to some birth control methods (such as an intrauterine device or birth control pills) infection of the uterus or cervix fibroids, polyps or ovarian cysts problems with blood clotting chronic medical conditions (for instance, thyroid problems and diabetes)
certain types of cancers (particularly cancer of the uterus, cervix, or vagina)
Diagnosis
To find the cause, your doctor will ask about your personal and family health history. You may be asked about these issues:
Your medical history (past or present illnesses)
Use of medications
Use of birth control
Weight, eating and exercise habits, and level of stress
Your doctor also will ask about your menstrual cycle. You can help by keeping track of it before your visit. Note the dates, length, and type (light, medium, heavy, or spotting) of your bleeding on a calendar (“Menstrual Flow Diary”). Your doctor can use your notes to help pinpoint the problem.
□ Pelvic ultrasound
Sound waves are used to make a picture of the pelvic organs.
□ Endometrial biopsy
Using a small catheter (tube), tissue is taken from the uterine lining and looked at under a microscope.
Julianne M. Dunne, MD, PC 1230 Mamaroneck Avenue Suite 100 White Plains, NY 10605 tel. (914) 948-1020 fax. (914) 948-1002 email: gyndocs1230@yahoo.com
