For many women, abnormal vaginal bleeding is caused by benign (not causing harm) abnormalities of the uterus or cervix. Benign conditions include fibroids, polyps, adenomyosis, and infection. Occasionally, malignant (dangerous) and premalignant conditions are the cause of abnormal vaginal bleeding. Such conditions include endometrial hyperplasia, endometrial carcinoma, and cervical carcinoma.
ABNORMAL VAGINAL BLEEDING: WHAT TO LOOK FOR
The normal interval between menstrual periods is 21 to 35 days. Most women have menstrual flow of no more than seven days, and lose no more than 2.8 ounces of blood with each cycle. Women with an interval less than 21 days or greater than 35 days, with menstrual flows greater than seven days’ duration, or with more than 80 cc of blood loss have abnormal bleeding.
Things to be aware of are:
- Bleeding between periods
- Heavy menstrual flow
- Large clots
- Menstrual flow lasting longer than seven days
- Vaginal bleeding after menopause
- Bleeding after intercourse
- Interval between periods lasting greater than 35 days
- Only having four to nine periods in a year
Diagnosis involves many factors. A physician will take into account:
- Pattern of abnormal bleeding
- Blood tests
- Physical exams
Your physician may also require additional tests to confirm your diagnosis. These include:
- Transvaginal ultrasound
- Hysteroscopy, and possible dialation & curettage.
ABNORMAL VAGINAL BLEEDING CAN VARY BY PATIENT
For medical treatment, hormonal irregularities may be treated with birth control that contains estrogen and progesterone. Non-steroidal Anti-Inflammatory Agents (NSAIDs) such as Ibuprofen and Naproxen, which are given for the duration of menstrual bleeding, have been shown to decrease blood loss during the menstrual period. NSAIDs are more effective when combined with birth control pills to control bleeding.
Surgical treatment can include:
- Dilatation and curettage (D&C), which is the fastest way to stop acute blood loss from the uterus. Those patients with severe bleeding and not responsive to medical therapy should have the procedure done to stop the bleeding.
- Hysteroscopy at the time of D&C may help identify an organic cause of bleeding, such as a uterine polyp or fibroid, which can be removed during the same procedure.
- Hysterectomy, a procedure that removes the uterus and the cervix will immediately stop monthly cycles and eliminate abnormal bleeding. This procedure can be used to treat fibroids, endometriosis, adenomyosis, and uterine cancers. This procedure should be discussed thoroughly with patients who are no longer interested in childbearing.
Note: Menopause begins early ONLY when the ovaries are removed, and the source of estrogen is gone.
A fellowship trained surgical specialist is the best choice to diagnose and treat abnormal vaginal bleeding definitively. Book a consultation with one of The Center for Innovative GYN Care specialists Dr. Paul MacKoul or Dr. Natalya Danilyants to help get you back to your life safer and faster.