Abnormal Uterine Bleeding/Irregular Periods
A woman’s body and cycles may change significantly as she goes through various life stages. Therefore, this can make it somewhat difficult to determine exactly what is normal – and what is not. The team at Grace Obstetrics and Gynecology is here to help you navigate these changes and manage your general health and wellness.
What Is the Menstrual Cycle?
A woman’s monthly cycle occurs over a 21- to 35-day period. The first day of the menstrual cycle is day one of menstruation. Menstrual bleeding occurs when the egg released by the ovaries is not fertilized, and the uterine lining must shed.
Menstruation may continue for a few days up to several days. Bleeding may be light or heavy, and may or may not coincide with pain such as cramping or back pain. Every woman is unique not only in her cycles but in the characteristics of menstruation from one month to another. Because of this, the range of what is normal is quite broad. However, it is possible to track menstruation in order to understand what is normal for you.
What Is Abnormal Uterine Bleeding?
There are several conditions that are classified as abnormal bleeding, including:
- Spotting or bleeding in between periods.
- Post-intercourse bleeding or spotting.
- Heavy menstrual bleeding, requiring a new pad every 1 to 2 hours.
- Fewer than 24 days or more than 38 days between periods.
- Variation in cycle length by 7 or more days.
- Post-menopausal bleeding.
Is Abnormal Bleeding Ever “Normal?”
Abnormalities in the menstrual cycle may occur more commonly among young women who are within two years of the onset of menstruation. Women in perimenopause may also notice more irregularities surrounding the menstrual cycle. Therefore, in both instances, widely fluctuating hormones may be the underlying cause.
Menstrual changes during these two stages in life may be more common. However, irregularities are important to note and discuss with a health care provider during routine visits, or if they occur frequently or become disruptive to quality of life.
Abnormal Bleeding Diagnosis
The more you know about your personal cycle, the better you can manage reproductive health. Menstrual tracking is easier when using a smartphone app, or with a physical calendar. Your healthcare provider may perform a pregnancy test, STD screening, hormone level testing, and other lab work to determine the cause of abnormal bleeding.
Additional testing may include:
- Ultrasound, MRI, or CT scan may be performed to observe pelvic organs.
- An endometrial biopsy removes a small tissue sample for microscopic examination.
- Hysteroscopy observes the inside of the uterus via a small lighted scope inserted vaginally.
- Sonohysterography observes the inside of the uterus that has been filled with fluid.
Abnormal Uterine Bleeding Causes
There are several reasons that a woman’s menstrual cycle may change. Diagnostic testing may coincide with common conditions related to a woman’s age group. Potential causes of abnormal uterine bleeding include:
- Ovulation problems
- Polyps or fibroids
- Ectopic pregnancy
- Uterine or other types of cancer
- Bleeding disorders
- Reaction to hormonal birth control or intrauterine device (IUD)
Does Abnormal Uterine Bleeding Require Surgery?
Not always. Abnormal uterine bleeding is only the symptom. In order to resolve it, it is important to address the underlying cause. When irregular periods are due to hormones, which is often the case, a birth control pill prescription or other hormone therapy may be necessary to establish routine ovulation and inhibit the excessive growth of the endometrial tissue. But if the irregularity is related to hormone replacement therapy, dosing may be modified. Abnormal bleeding related to a primary health condition, such as thyroid dysfunction, may resolve with appropriate thyroid treatment.
Does Surgical Treatment Mean Hysterectomy?
Hysterectomy is no longer the only surgical method used to treat abnormal uterine bleeding. This procedure, which removes the uterus, is a definitive option some women may choose, based upon the conditions being experienced. Also, a hysterectomy may be performed when conservative treatment methods have failed to resolve irregular bleeding.
Other procedures that may treat abnormal uterine bleeding include::
- Endometrial ablation. By destroying the uterine lining, this procedure may greatly reduce or completely stop abnormal bleeding. Endometrial ablation is typically only for severe abnormalities due to the fact that the patient cannot become pregnant in the future. Pregnancy is possible, but with a risk for serious complications. A reliable method of birth control is necessary until menopause.
- Uterine artery embolization. This surgery inhibits blood flow to certain vessels in the uterus. As a result, this prevents circulation to uterine fibroids that are causing menstrual irregularities and pain.
- Myomectomy is the surgical removal of fibroids themselves. The uterus remains intact after this procedure.