Abnormal vaginal bleeding is a flow of blood from the vagina that occurs either at the wrong time during the month or in inappropriate amounts. In order to determine whether bleeding is abnormal, and its cause, the doctor must consider three questions:
- Is the woman pregnant?
- What is the pattern of the bleeding?
- Is she ovulating?
Every woman who thinks she has an irregular menstrual bleeding pattern should think carefully about the specific characteristics of her vaginal bleeding in order to help her doctor evaluate her particular situation. Her doctor will require the details of her menstrual history.
Each category of menstrual disturbance has a particular list of causes, necessary testing, and treatment.
Every woman’s menstrual cycle, or period, is different. On average, a woman’s period occurs every 28 days. Most women have cycles between 24 and 34 days apart. It usually lasts 4 – 7 days.
Young girls may get their periods anywhere from 21 to 45 days or more apart. Women in their 40s will often notice their period occurring less often.
About every month, the levels of female hormones in a woman’s body rise and fall. Estrogen and progesterone are two very important hormones. These hormones play an important role in ovulation, the time when the ovaries release an egg.
Dysfunctional uterine bleeding (DUB) most commonly occurs when the ovaries do not release an egg. Changes in hormone levels cause your period to be later or earlier and sometimes heavier than normal.
Symptoms of dysfunctional uterine bleeding may include:
- Bleeding or spotting from the vagina between periods
- Periods that occur less than 28 days apart (more common) or more than 35 days apart
- Time between periods changes each month
- Heavier bleeding (such as passing large clots, needing to change protection during the night, soaking through a sanitary pad or tampon every hour for 2 – 3 hours in a row)
- Bleeding lasts for more days than normal or for more than 7 days
Other symptoms caused by changes in hormone levels may include:
- Excessive growth of body hair in a male pattern (hirsutism)
- Hot flashes
- Mood swings
- Tenderness and dryness of the vagina
- A woman may feel tired or have fatigue if she is loses too much blood over time. This is a symptom of anemia.
What conditions cause vaginal bleeding after menopause or abnormal vaginal bleeding in women who are not ovulating regularly?
Many conditions can interfere with the proper function of female hormones that are necessary for ovulation. For example, many conditions or circumstances may cause oligomenorrhea (reduction in the number of menstrual periods and/or amount of flow than usual) such as:
- If a woman has chronic medical illnesses or is under significant medical or emotional stress, she can begin to have a loss of her menstrual periods.
- Malfunction of a particular part of the brain, called the hypothalamus, can cause oligomenorrhea.
- Anorexia nervosa is an eating disorder associated with excessive thinness that causes many serious medical consequences as well as oligomenorrhea or amenorrhea (the absence of menstrual periods).
- Polycystic ovarian syndrome (PCO or POS) is a hormonal problem that causes women to have a variety of symptoms that include irregular or no menstrual periods, acne, obesity, infertility, and excessive hair growth; that are detectable with blood tests.
The complete loss of ovulation is referred to as anovulation. Since ovulation allows the body to maintain an adequate supply of progesterone, anovulation is a condition in which a woman’s hormonal balance is tipped toward too much estrogen and not enough progesterone.
The excess estrogen stimulates the growth of the lining of the uterus. The result is that the lining of the uterus becomes too thick, which eventually leads to an increased risk of uterine pre-cancer or uterine cancer over many years.
In order to replace progesterone and establish a proper hormonal balance, doctors will prescribe either progesterone to be taken at regular intervals, or an oral contraceptive that contains progesterone. Such treatment dramatically decreases the risk of uterine cancer in women who do not ovulate.
Because uterine cancer results from many years of anovulation, any woman with prolonged anovulation needs to be treated to avoid developing uterine cancer.
Exams and Tests
The health care provider will do a pelvic examination and may perform a Pap smear. Tests that may be done include:
- Complete blood count (CBC)
- Blood clotting profile
- Hormone tests
- Male hormone (androgen) levels
- Pregnancy test
- Thyroid function tests
- Pap smear and culture to look for infection
Your health care provider may recommend the following:
- Biopsy to look for infection, precancer, or cancer, or to help decide on hormone treatment
- Hysteroscopy, performed in the doctor’s office, to look into the uterus through the vagina.
- Transvaginal ultrasound to look for problems in the uterus or pelvis
Young women within a few years of their first period are often not treated unless symptoms are very severe, such as heavy blood loss causing anemia.
How is irregular vaginal bleeding treated?
Treatment for irregular vaginal bleeding depends on the underlying cause. After the cause is determined, the doctor decides if treatment is actually necessary.
Sometimes, all that is needed is for dangerous causes to be ruled out and to determine that the irregular vaginal bleeding does not bother the woman enough to warrant medication or treatment.
If thyroid, liver, kidney, or blood clotting problems are discovered, treatment is directed toward these conditions.
Medications for treatment of irregular vaginal bleeding depend on the cause.
In other women, the goal of treatment is to control the menstrual cycle. Treatment may include:
- Birth control pills or progesterone only pills
- Intrauterine device (IUD) that releases the hormone progestin
- Ibuprofen or naproxen taken just before the period starts
The health care provider may recommend iron supplements for women with anemia.
If you want to get pregnant, you may be given medication to stimulate ovulation.
Women with severe symptoms that do not get better with other treatments may consider the following procedures if they no longer want to have children:
- Endometrial ablation or resection to destroy or remove the lining of the uterus
- Hysterectomy to remove the uterus
- D and C to remove polyps and diagnose certain conditions
Hormone therapy usually relieves symptoms. Treatment may not be needed if you do not develop anemia due to blood loss.
- Infertility (inability to get pregnant)
- Severe anemia due to a lot of blood loss over time
- Increased risk for endometrial cancer
When to Contact a Medical Professional
Call your health care provider if you have unusual vaginal bleeding.
Abnormal vaginal bleeding; Bleeding – dysfunctional uterine; Anovulatory bleeding; DUB; Abnormal uterine bleeding; Menorrhagia – dysfunctional; Polymenorrhea – dysfunctional; Metrorrhagia – dysfunctional; Dysfunctional uterine bleeding.