One of the most common reasons for visits to the gynecologist is abnormal bleeding. Abnormal bleeding can cause significant stress, discomfort and disruption to a woman’s life. Approximately 10 million women are affected by this condition each year. The most common forms of abnormal bleeding are:
- Bleeding or spotting that occurs between periods.
- Menstrual cycle that is heavier and lasts longer than normal.
- Bleeding during or after sex.
- Bleeding that occurs around or after menopause.
The most common time that abnormal bleeding can occur is when a woman starts having her period (puberty) and near menopause when she stops having her period (perimenopause), but abnormal bleeding can occur at any time during a woman’s reproductive life. The most common reasons for abnormal bleeding fall into the following areas:
- Fibroids, polyps and cervical lesions
- Bleeding disorders
- No known reason
Abnormal Bleeding During Pregnancy
If you are of reproductive age, one of the first things your doctor will ask about is the possibility of pregnancy, especially if you’re not using contraception. Many cases of bleeding may occur in early pregnancy, but bleeding can occur at any time during pregnancy and typically needs immediate evaluation.
Hormonal Causes of Abnormal Bleeding
The most common reason for hormonal abnormalities is typically related to a dysfunction of ovulation. Ovulation is the release of an egg from the ovary that typically occurs about two weeks before the start of your menstrual cycle. Abnormalities are most common during puberty and perimenopause. When entering puberty, the communication between the brain (hypothalamus and pituitary gland) and the ovaries can be immature and may lead to irregular periods/bleeding. The same is true during perimenopause. In this case, the signals to the ovary are intact, but because of the age-related effects in the ovary, it does not always release an egg in a timely fashion. Other reasons for a dysfunction in ovulation may be related to other hormones, such as thyroid disorders. Your provider may perform lab tests as part of this evaluation to check various hormones and, if your bleeding is significant, indications of anemia.
Abnormal Bleeding Caused by Fibroids, Polyps and Cervical Conditions
Anatomic or structural abnormalities of the reproductive tract are another very common reason for abnormal bleeding. Bleeding that falls into this category may arise from the cervix (where your doctor obtains a pap smear), the lining of the uterus (which is shed every month during your period), or the body of the uterus.
Conditions, such as fibroids, polyps and conditions of the cervix should all be evaluated. Fibroid tumors are benign tumors that can be common culprits in abnormal bleeding. Fibroids typically arise from the uterus and are composed of muscular tissue. Fibroids may also cause pain, pelvic pressure, urinary frequency or constipation and infertility. Polyps can also cause abnormal bleeding and may be found on the cervix or inside the uterus.
A pelvic exam and ultrasound can detect most anatomic abnormalities. If the inside of the uterus needs to be further evaluated, your doctor may also recommend a saline infusion ultrasound (SIS) or hysteroscopy. SIS involves putting a small amount of saline (water) into the uterine cavity while performing an ultrasound to better define the endometrial cavity. This can help locate small polyps or fibroids that may be impacting your bleeding and/or infertility. A hysteroscopy involves inserting a small camera into the uterus for the same purpose. Both of these procedures are easily accomplished in our offices.
Abnormal Bleeding May Be a Sign of Cancer
Uterine cancer may be discovered as a result of abnormal bleeding. This is most common after menopause or during perimenopause. Your doctor typically evaluates this by performing an endometrial biopsy, which is a test that samples the lining of the uterus. This is performed at an office visit. Certain risk factors, such as age, obesity, diabetes or chronic problems with ovulation may increase your risk of uterine cancer.
Bleeding Disorders and Medications
Bleeding disorders or certain medications may contribute to abnormal menstrual bleeding. If you have a history of easy bruising, bleeding from your gums when brushing your teeth or bleeding excessively from a small cut, you should discuss this with your doctor. Be sure to mention if you are taking blood thinners for a medical condition, as sometimes this will cause heavy periods or bleeding mid-cycle during ovulation. Other medications that may cause abnormal bleeding are hormonal birth control methods and hormone replacement therapies.
Abnormal Bleeding For No Apparent Reason
After the above conditions have been investigated, your doctor may find that all appears normal. This is actually a common occurrence, but rest assured there are still many medical and surgical options available to you to address abnormal bleeding.
Treatment options for abnormal bleeding can be broken down into medical management and surgical options. Medical options may include birth control pills, progestin medication, hormonal IUD, non-steroidal anti-inflammatory agents or adjustment to current medications. Surgical options may include treatment for cervical lesions, polyps or fibroids.
For more details on treatment options, please refer to my other articles in the Wellness Journal, which you can find by clicking my name below. If you are interested in a consultation, please contact our office to schedule an appointment.
Dr. Liberato Mukul is a board-certified OB/GYN physician and fellowship-trained in minimally invasive gynecology. He sees patients at Northwest Gynecology Center, Peterkort. His clinical focus includes menstrual irregularities, fibroid treatment options, endometriosis, ovarian cysts, pelvic pain, polycystic ovary syndrome and infertility. In his spare time, Dr. Mukul enjoys spending time with his family, hiking, soccer and travel. He is fluent in Spanish.