Abnormal Vaginal Bleeding

Menstruation occurs approximately every 21 to 35 days in reproductive-aged women. Abnormal uterine bleeding is any bleeding unrelated to normal menstruation. This may be any bleeding between periods or menstrual flow which is heavier than normal.

Causes

Some possible causes of abnormal uterine bleeding include:

Polyps (abnormal outgrowth of tissue)
Adenomyosis
Fibroids (benign tumors)
Cancer of the uterus, cervix, or vagina
Hormonal changes
Contraception pills or intrauterine device (IUD)
Infection
Problem with blood clotting
Trauma
Vascular malformation

Symptoms

Symptoms of abnormal uterine bleeding include bleeding between periods or after sex, spotting after menstruation, bleeding heavier or for more days than normal, and bleeding after menopause.

Diagnosis

Your doctor will examine your personal and family health history as well as complete details of your menstrual cycles (dates, length, and type of bleeding). You will also have a physical examination and possibly blood tests to help determine the cause of your bleeding. Your doctor may also order a pregnancy test to rule out the possibility of pregnancy. A range of imaging tests such as ultrasound or MRI scans, which produce images of your internal organs, may also be ordered to diagnose irregular bleeding. A cervical smear and swab may be taken and sent for sampling to determine any abnormalities.

Treatment

The type of treatment offered for abnormal bleeding is based on many factors, such as the cause of bleeding, age, and the desire for future fertility. Most cases of abnormal uterine bleeding can be treated with medications, except for a few cases which may require surgery.

Medications

Hormonal medications used to treat abnormal bleeding depend on whether or not you want to get pregnant, your medical history, and age. Hormones can be given as injections, vaginal creams or through intrauterine devices (birth control device which is inserted into the uterus). The hormones are slowly released into the body by these means and control the abnormal bleeding. Your doctor may also prescribe other medications, such as anti-inflammatory drugs or antibiotics to treat other causes of bleeding.

Surgical treatment

Your doctor may recommend surgical treatment, depending on your specific circumstances. Surgery may be performed to excise polyps or fibroids by a procedure called hysteroscopy, which uses a flexible tube or endoscope. Some other procedures like endometrial ablations (burning of a thin layer of the uterine wall to reduce bleeding) may also be recommended. Referral to an interventional radiologist for a procedure called uterine artery embolization (UAE) may even be suggested Hysterectomy (surgical removal of the uterus) may be considered if all other forms of treatments have failed or found to be unacceptable options. You can no longer conceive after hysterectomy.