Our Specialized Surgeons Diagnose and Treat Abnormal Bleeding
The normal interval between menstrual periods is 21 to 35 days. Most women have a duration of flow of no more than seven days, and lose no more than 80 cc (or 2.8 fluid ounces) of blood with each cycle. Women with an interval of less than 21 days or greater than 35 days, with a menstrual flow duration greater than seven days, and/or with more than 80 cc of blood loss have abnormal bleeding.
Abnormal Bleeding Causes
Most commonly, abnormal vaginal bleeding is caused by benign abnormalities of the uterus or cervix. Benign conditions include fibroids, polyps, adenomyosis, and infection. Occasionally, malignant and premalignant conditions are the cause of abnormal bleeding. Such conditions include endometrial hyperplasia, endometrial carcinoma, and cervical carcinoma.
Systemic conditions, such as bleeding disorders, liver disease, pregnancy, and some medications, such as oral contraceptives, can cause irregular bleeding. Hormonal disorders such as polycystic ovary syndrome (PCOS), premature ovarian failure, and thyroid and pituitary abnormalities can also cause abnormal bleeding. When no organic cause of abnormal bleeding is identified, the patient is diagnosed with dysfunctional uterine bleeding (DUB).
Abnormal Bleeding Symptoms
Symptoms of abnormal bleeding include:
- Abnormal periods or bleeding between menses
- Heavy menstrual flow
- Large clots
- Menstrual flow lasting longer than seven days
- Any bleeding after menopause
- Any bleeding after intercourse
- Interval between periods lasting greater than 35 days
- Only having four to nine periods in a year
Abnormal Bleeding Diagnosis
The patient’s age as well as the pattern of abnormal menstrual bleeding is extremely important in identifying the cause. A careful medical history is obtained to evaluate the frequency and the amount of bleeding. Blood tests such as blood count, clotting factors, and iron levels can also be helpful in diagnosing abnormal bleeding and can identify the patients who need to be treated with iron supplementation.
Physical exams are performed to identify cervical or uterine masses or lesions:
- Pelvic exams can be helpful in diagnosing some conditions, such as vaginal vault prolapse, as well as assessing the cervix and vagina
- However, pelvic exams are not very accurate for diagnosing early-stage endometriosis or for evaluating the size, number, and location of fibroids and pelvic exams can miss more worrisome problems like ovarian masses — ultrasound should be considered in any patient with abnormal bleeding or if pathology is suspected
- Transvaginal ultrasound is a simple, noninvasive test that yields a large amount of information regarding the uterus, tubes, and ovaries, and can measure the thickness of the endometrial lining
- The thickness of the endometrial lining can vary considerably for patients of reproductive age and should be less than 5 mm in postmenopausal patients
- Hysteroscopy — where a small camera is inserted into the uterine cavity through the cervical canal — is useful in evaluating the uterine cavity and identifying polyps, fibroids, hyperplasia, and malignant lesions
- If polyps or fibroids are identified, they can be removed by hysteroscopic resection
- D&C may follow hysteroscopy if there is no evidence of an obvious abnormality within the uterine cavity and the tissue obtained from curettage is then sent for pathologic evaluation
Abnormal Bleeding Treatments
The treatment of abnormal bleeding is personalized for each patient and is based on the underlying cause of bleeding. Patients with DUB are usually treated with medical therapy, since there is not a specific lesion (organic cause) amenable to surgical therapy. Those who fail to respond to medical therapy should consider surgical options. Patients with anatomic causes of abnormal bleeding, such as fibroids, polyps, or cancer, are managed with surgical therapy. If a systemic (e.g., liver disease) or hormonal condition (e.g., thyroid disease) is the cause of abnormal bleeding, treatment of that condition will usually resolve the abnormal bleeding.
Medical Treatments Available1
- Birth control pills are often used to treat abnormal bleeding that is due to hormonal irregularities
- Birth control pills have many benefits and are safe for long-term use. Progesterone-only pills and intrauterine devices (IUDs) are used in women with a thickened uterine lining. Progesterone keeps the lining thin and can prevent the development of hyperplasia and uterine cancer.
- 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 Treatments Available1
- Dilation and curettage (D&C) 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. D&C provides only short-term relief from DUB. Medical therapy should be instituted after the bleeding has been controlled. 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.
- Endometrial ablation is the destruction of the endometrial lining with thermal energy and should be considered in patients with DUB who have failed to respond to medical therapy
- Energy-delivering devices include cryotherapy, circulating hot fluid, thermal balloons, radiofrequency electrosurgery, microwave energy, and diode laser energy, as well as monopolar and bipolar devices. Endometrial ablation can be performed in the office with local anesthesia and IV sedation or in the operating room with IV sedation or general anesthesia. Endometrial ablation should only be used in patients who do not desire fertility but desire to retain the uterus. Patients with multiple and/or large fibroids or patients with other organic causes of abnormal bleeding (such as adenomyosis) should not undergo this procedure. An 80 percent success rate can be achieved in select patients. Twenty percent of patients will require either another ablative procedure or hysterectomy2.
- Undergoing a hysterectomy is best for patients who are not candidates for endometrial ablation, who are not interested in future childbearing, and who desire a guaranteed cure for their condition
- Hysterectomy refers to removal of the uterus only — the ovaries are not removed and will continue to make estrogen, the female hormone. It is estrogen, not the uterus, which prevents patients from going into menopause.
- Myomectomy, or the removal of fibroids while preserving the uterus, is usually reserved for patients who desire to preserve fertility
The CIGC Difference
When you suffer from abnormal bleeding, it is stressful not knowing why. When the bleeding is severe, it is important to find a GYN specialist whom you trust to avoid further complications.
Specialists not OBGYNs
At The Center for Innovative GYN Care® (CIGC®), we are completely focused on performing minimally invasive GYN techniques and procedures for optimal care and rapid recovery. Our surgeons specialize in GYN surgery for complications like abnormal bleeding. While the OBGYNs main focus is obstetrics, our sole focus is advanced gynecological surgery. The average OBGYN performs only 10 to 15 hysterectomies per year, while our surgeons average 400 per year. Surgical volume along with advanced techniques and procedures are important for success. Read more about why patients from all over the US and the world travel to CIGC for surgical care.
CIGC physicians will discuss all treatment options available, and, working together with patients, will decide on the best approach for each individual problem. CIGC surgeons will also make sure that you are fully informed about the treatment you receive, whether it is a simple prescription for birth control pills or a D&C.
A safe and speedy recovery is our priority. CIGC physicians have extensive experience with each procedure and have seen all possible outcomes, so they can ensure your comfort by telling you what to expect. As a patient, it is your decision where to get treated. As experts in this field, we urge you to visit us and find peace of mind in the form of superior expertise and years of experience.
Abnormal Bleeding FAQs
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If you think you have abnormal bleeding, our specialists are ready to provide an evaluation of your symptoms and condition(s) and recommend an appropriate solution.
Related Blog Posts
1 Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Committee Opinion No. 557. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2013;121:891–6.
2 Famuyide A. Endometrial Ablation. J Minim Invasive Gynecol. 2018 Feb;25(2):299-307