Abnormal uterine bleeding can occur for a number of reasons, including problems with ovulation, a hormonal imbalance or abnormalities of the vagina, cervix or uterus.
Abnormal bleeding includes:
- Bleeding that is prolonged – longer than a woman’s normal menstrual period
- Too frequent – less than 21 days from the first day of one episode of bleeding to the first day of the next
- Heavier than usual or requiring more than a pad every hour during the heaviest time
Common reasons for abnormal uterine bleeding include:
- Anovulation – Lack of normal cyclic bleeding due to problems with hormone secretion by the ovary. This usually can be diagnosed by a history and physical examination. Blood tests for hormone levels are sometimes helpful. Treatment usually involves correcting the hormonal imbalance with medication.
- Abnormalities of the vagina and cervix – Infections or other conditions of the vagina and cervix sometimes can cause bleeding, though usually this is light and may be associated with intercourse. Post-menopausal women sometimes can have thinning of the vaginal walls that can lead to light bleeding. Abnormalities of the cervix, including cervical cancer, also can cause bleeding. These conditions can be diagnosed by physical examination and office tests.
- Uterine Fibroids – Fibroids are non-cancerous (benign) growths that develop within the uterus. Most women with fibroids have no symptoms and don’t need treatment. When symptoms occur, women should seek medical attention.
- Endometrial polyps – These are benign growths in the uterine lining that can lead to irregular uterine bleeding. They can be removed by hysteroscopy, a procedure during which a slender “telescope” is inserted through the vagina and cervix into the uterine cavity to allow examination of the cavity and removal of the polyps.
- Endometrial cancer – In women who have experienced menopause, abnormal bleeding can sometimes be a sign of endometrial cancer, or cancer of the lining of the uterus. This usually can be diagnosed by tests done in the office, including an endometrial biopsy in which some cells are removed from the endometrius. Endometrial cancer can be treated with surgery if diagnosed early.
To determine the cause of abnormal uterine bleeding, patients undergo a pelvic exam, including a Pap smear and lab tests to check for any underlying causes. A pregnancy test may also be done when appropriate. An ultrasound is used to check for any abnormalities, such as fibroids. An endometrial biopsy, hysteroscopy, or D&C may also be performed to further evaluate the condition of your uterus.
Heavy bleeding often can be decreased or stopped by endometrial ablation, a procedure in which the uterine lining is removed or destroyed. Some women choose hysterectomy, or removal of the uterus, as the most definitive way of ending abnormal bleeding once and for all.
Abnormal bleeding may be treated with hormones such as oral contraceptive pills. Sometimes hysteroscopy is required to remove a polyp or small fibroid.