The Female Reproductive Cycle
To understand abnormal bleeding, it helps to understand what is normal. Vaginal bleeding, or menstruation, is what takes place as a normal part of the reproductive cycle and is commonly referred to as a “period”. Normally, each month an egg is released from one ovary and travels through the fallopian tube to the uterus to await fertilization. When fertilization doesn’t occur the uterus sheds its inner lining (endometrium) through the vagina in order to prepare the uterus to accept a new embryo during the next cycle. The amount of fluid and blood that is shed during normal menstruation varies but is usually between 4 and 12 teaspoons. The length of the menstrual cycle can vary from 21 days to 35 days with the average length of a cycle being 28 days. A normal period lasts from 2 to 7 days.
When periods are heavier than a woman would expect or the flow takes place at the wrong time during the month (i.e., irregularly), it is considered abnormal, and it is suggested that you consult your gynecologist in order to determine the cause.
Bleeding is always considered abnormal, regardless of the quantity, if it occurs more than once every 21 days (counting from the start of one episode to the start of the next, regardless of how many days each episode lasts), after intercourse, or after menopause. Bleeding is also considered abnormal if your regular period becomes heavier or lasts longer than it used to. If you are experiencing any of these conditions you should consult with your ob gyn to discover the cause.
Sometimes irregular bleeding may be your first indication of pregnancy, and a pregnancy test is one of the first tests your doctor is likely to do. If pregnancy is confirmed your doctor will continue to monitor you for any new episodes since vaginal bleeding during the pregnancy can be an indication of miscarriage or ectopic pregnancy.
If you are not pregnant, it can be helpful for you to provide your gynecologist a bleeding diary that details your bleeding pattern and the amount of bleeding you experience each day. Though quantifying the amount that you bleed can be difficult, your doctor will want to know how often you have to change your sanitary pad or tampon, if you pass blood clots, and if you have had problems with anemia as a result of too much blood loss.
What are the causes of abnormal bleeding?
There are many causes of abnormal bleeding. Concerns range from pregnancy complications to cancer. Common reasons for abnormal bleeding are fibroid tumors of the uterus, polyps of the endometrium, and hormonal imbalances that cause disruption of the normal ovulation cycle. By providing a good bleeding history, you can help your doctor determine the cause.
After hearing your history, your doctor will determine which tests are necessary to make a diagnosis. Your work-up might include blood tests, a pelvic ultrasound, a pap smear, and/or a biopsy of the endometrium.
How is irregular vaginal bleeding treated?
The first priority is to determine what causes the irregular bleeding. Once the cause is diagnosed, your gynecologist can consult with you to decide if treatment is actually necessary. In some cases, if the dangerous causes have been ruled out, you and your doctor may decide that the irregular bleeding may not be enough of a problem to warrant medication or treatment.
If the abnormal bleeding is determined to be serious enough to threaten your health or if you feel that treatment is necessary because of the impact it is having on your lifestyle, then your doctor will recommend treatment that is appropriate for your specific diagnosis. Sometimes treatment with medications is likely to help; other times, surgical treatment is more appropriate. Most medications used for bleeding problems contain hormones, though there are some non-hormonal treatments available as well. Surgeries often performed for abnormal bleeding include using a camera to remove polyps and other growths from the uterine cavity (hysteroscopy), destruction of the uterine lining (endometrial ablation), removal of fibroid tumors (myomectomy), or removal of the uterus (hysterectomy).
To schedule an examination call Health Care for Women in Salinas, California, or for any other questions or concerns you may have concerning gynecology, obstetrics, healthy pregnancies or general women’s healthcare, please call 831-758-8223, or visit the Health Care for Women website and get in contact today.