This term is a catchall for problems associated with vaginal bleeding. This may be related to the menstrual cycle, but at times abnormal bleeding may occur before the onset of menses, during pregnancy and after menopause.
Overwhelmingly, bleeding problems are caused by an imbalance in the hormones that control the menstrual cycle and are referred to as “dysfunctional uterine bleeding.” When vaginal bleeding is not related to the menstrual cycle, it is of increased concern. This is especially true when it occurs in childhood before menstruation has begun, during pregnancy, and at midlife, after a woman has entered menopause.
When to call your health care provider:
- Periods less than 21 days apart or more than 45 days apart
- Severe abdominal or pelvic pain occurs during menstruation or sexual intercourse
- Menstrual bleeding is excessive (more than one pad or tampon per hour for several hours)
- Menstrual periods lasting longer than 7 days
- Bleeding or spotting between periods
Abnormal vaginal bleeding may be more likely associated with the following:
In a young, pre-pubertal girl
• Sexual abuse
• A blood clotting problem
• Early puberty
• Severe vaginal irritation (bubble bath, etc.)
In a woman of reproductive age
• Hormone imbalance
• Tubal or ectopic pregnancy
• Molar pregnancy
• Placenta previa - pregnancy where the placenta lies low near or over the cervix
• Uterine fibroids
• Certain kinds of cysts and tumors (rarely cancerous)
• Birth control pills
• IUD (intrauterine device)
In post-menopausal women
• Effects of hormone replacement therapy
• Certain kinds of cysts and tumors (not cancerous)
• Atrophic vaginitis (irritation and drying)
• Weakened pelvic floor muscles causing prolapse
Diagnosis and treatment
Evaluation of abnormal uterine bleeding includes ultrasound, endometrial biopsy or D&C. Typical diagnosis include: unexpected pregnancy, fibroid uterus, polyps, endometriosis, perimenopausal or menopausal uterine changes, cysts and tumors.
Treatment typically includes, a trial of hormonal birth control using oral, injection or IUD delivery to reduce bleeding, cramps and pain. Other prescription medication may be prescribed to either slow bleeding down.
In some cases, surgical treatments to address abnormal uterine bleeding may be the best option. Surgical procedures include hysteroscopy, endometrial ablation, uterine artery embolization, hysterectomy, exploratory laparatomy through an abdominal incision, vaginal approach, laparoscopy or robotic assistance. Hysterectomy is considered only when a permanent treatment is required and fertility is no longer desired.
Hysteroscopy – a procedure that takes a look inside the uterus through a scope. The physician can see the lining of the uterus (endometrium) and the openings of the fallopian tubes. It allows direct view of the uterine lining and the ability to take samples of tissue. This procedure is minimally invasive and may be performed in an office or outpatient setting.
Operative Hysteroscopy – While the physician is visualizing the uterus and endometrial lining, he may remove polyps, fibroids or perform a D&C. This procedure is typically performed in a surgi-center setting.
Endometrial Ablation – a procedure using either heat or cold energy to destroy the endometrial lining of the uterus. This procedure can be performed in the office or surgi-center setting. Bleeding tends to be significantly less than before the procedure. An endometrial ablation should only be considered for women who no longer wish to become pregnant and permanent treatment is desired .
Endometrial biopsy – this procedure is obtains a sample of the endometrial lining and is usually performed at your physician’s office. It involves the insertion of a plastic pipelle (a small flexible tube), thru the opening of the cervix, into the uterus. Using suction, the pipelle plucks off a sample of tissue from the uterine lining and it is removed for laboratory examination.
D & C – a procedure performed to obtain samples of the endometrium, the lining of the uterus to evaluate abnormal uterine bleeding or abnormal cells that may be from the uterus that were found during routine screening for cervical cancer. A D&C is typically performed when an endometrial biopsy is not possible or if the sample of the tissue was inadequate. This procedure typically is performed in the office or surgi-center setting
Laparoscopy – a surgical procedure using key-hole sized incisions and a thin telescope like instrument that allows the physician to visualize operate on the uterus, fallopian tubes, ovaries and surrounding tissue. This procedure is performed in a surgi-center.
Hysterectomy – a surgical procedure performed by laparoscopy, robotic assistance, vaginally or by an open incision that removes the uterus with or without ovarian removal. This procedure typically is performed in a hospital setting and requires a period of observation.