Erratic bleeding or excessive regular menstrual bleeding is considered as abnormal uterine bleeding. The uterus has two layers, a thin layer called endometrium and thick outer layer called myometrium. During menstruation the endometrial lining is shed. This results in limited blood loss. The causes, evaluation and treatment strategies for abnormal uterine bleeding are discussed below.
Most abnormal uterine bleeding can be associated to a particular age in a woman’s life.
- In young girls: Bleeding before menarche or the first menstrual period is abnormal. It may be caused by any foreign body such as toys, by trauma, by sexual abuse, by irritation in the genitals or by urinary tract problems.
- In Adolescents: irregular bleeding may occur a few months after menarche but gradually it gets resolved without treatment when the menstrual cycle and ovulation becomes normal. But if bleeding persists for a long time, consultation with doctor is suggested.
- In Premenopausal women: In women between adolescence and menopause, during ovulation, changes in hormone levels can cause small amount of bleeding or vaginal spotting. But some women ovulate normally and experience excessive blood loss during or between periods. The most common cause in such cases is fibroids, adenomyosis and polyps. Other causes include pregnancy, infection of the cervix or endometrium, cancer of the cervix or endometrium, hypothyroidsm, liver disease,clotting disorders etc
- Hormonal Birth control: Women who take hormonal birth control like pills, patch, ring etc may experience excessive bleeding during the first few months. If it continues for more than few months you need to consult with your gynecologist.
- Women in menopausal transition: Women are more likely to experience abnormal uterine bleeding during menopausal transition due to changes in hormone levels and inconsistent ovulation.
- Menopausal women: abnormal bleeding can be caused by many factors during menopause such as in women who take hormone therapy. Other causes include polyps or fibroids, excessive thinning of the tissue lining the vagina and uterus, infection of the uterus, cancer, use of blood thinners, radiation therapy etc.
Your physician might suggest an Initial Assessment by collecting your medical history, family history, factors that bring abnormal bleeding, the causes, the duration etc. They might also perform a physical pelvic examination to evaluate your overall health. Other tests include
- Lab tests- Pregnancy test may be performed in premenopausal women. Blood tests are performed to check for thyroid, kidney or liver diseases. Cervical culture may be performed in case of abnormal vaginal discharge.
- Ovulatory Status determinant Tests can be performed to check if a woman ovulates during each period. This may show discrepancies because of hormonal irregularities.
- Endometrial assessment test can be performed to check for endometrial cancer or structural abnormalities such as fibroids. These tests include endometrial biopsy, saline infusion sonography, transvaginal ultrasound, hysteroscopy etc.
- Birth control pills: Abnormal uterine bleeding caused due to hormonal irregularities can be treated using birth control pills.
- Progesterone: Women who do not ovulate regularly can be given progestin, a synthetic form of the hormone progesterone to treat abnormal bleeding.
- Intrauterine Device: IUD secreting progestin for example Mirena can be used to control excessive bleeding.
- Surgery: Abnormal uterine growths such as polyps or fibroids can be removed surgically.