Abnormal Bleeding

What is Abnormal Bleeding?

Normal vaginal bleeding (menstruation) occurs every 28 to 35 days in women. Abnormal bleeding is any bleeding that occurs outside the normal menstrual cycle or in excessive amounts. It may present as heavy or prolonged menstrual bleeding, irregular or frequent uterine bleeding between periods, infrequent or light menstrual bleeding, heavy or prolonged bleeding at irregular intervals, or bleeding following intercourse.

Causes Of Abnormal Bleeding

There are many possible causes of abnormal bleeding, which can be broadly categorised as follows:

Hormonal imbalances: Abnormal bleeding can occur when the levels of hormones like oestrogen and progesterone are not balanced. This can happen due to hormonal changes associated with conditions like polycystic ovary syndrome (PCOS), thyroid disorders, or menopause.
Pregnancy complications: Abnormal bleeding can occur in early pregnancy due to implantation bleeding, an ectopic pregnancy, or a miscarriage. It can also occur later in pregnancy due to placenta previa or placental abruption.
Structural problems in the reproductive system: Abnormal bleeding can be caused by structural issues like fibroids, polyps, or cancer in the uterus, cervix, or ovaries. It can also occur as a result of pelvic infection or endometriosis.
Bleeding disorders: Certain bleeding disorders, such as von Willebrand disease or a deficiency in clotting factors, can cause abnormal bleeding.
Medications or medical conditions: Certain medications like blood thinners or hormonal contraceptives can cause abnormal bleeding. Medical conditions like liver or kidney disease can also cause abnormal bleeding.

Symptoms Of Abnormal Bleeding

Symptoms of abnormal bleeding can vary depending on the underlying cause, but they may include the following:

Heavy or prolonged menstrual bleeding: Menstrual bleeding that lasts longer than seven days or involves the use of multiple pads or tampons per day.
Irregular or frequent uterine bleeding: Bleeding occurs between periods or periods less than 21 days apart.
Vaginal bleeding after sex (postcoital bleeding): occurs immediately after or several days after sexual intercourse.
Vaginal bleeding during pregnancy: Any bleeding during pregnancy should be evaluated by a healthcare provider as it can indicate a potential risk to the pregnancy.
Vaginal bleeding in children and adolescents: Any vaginal bleeding in girls who have not yet begun menstruation or are not yet of reproductive age should be evaluated by a healthcare provider.
Spotting or light bleeding: less bleeding but more frequent than normal.
Abdominal pain or cramping: abdominal pain or cramping that may accompany abnormal bleeding
Fatigue or weakness: Feel tired or lightheadedness that may be a sign of blood loss

Diagnosis Of Abnormal Bleeding

To diagnose abnormal bleeding, Dr Crawford may begin with a thorough medical history and physical examination. This may be followed by additional tests and procedures, such as:

Pelvic exam: A pelvic exam allows a healthcare provider to inspect the pelvic organs, including the uterus, ovaries, and cervix, for any signs of structural abnormalities or growth.
Cervical screening test (Pap smear): This test is used to check for cervical cancer or other changes in the cervix that may cause abnormal bleeding.
Blood tests: Blood tests may be used to check for hormonal imbalances, bleeding disorders, or other medical conditions causing abnormal bleeding.
Ultrasound: Ultrasound can visualise the reproductive organs and check for structural abnormalities or growths, such as fibroids, polyps, or cysts.
Biopsy: A biopsy is a procedure that involves removing a small sample of tissue from the uterus, cervix, or other reproductive organs to be analysed under a microscope. This can help determine the cause of abnormal bleeding.
Endometrial sampling: A thin tube is inserted through the cervix into the uterus, and a small amount of tissue is taken. This procedure checks for abnormal growths or changes in the uterus lining.

Treatments For Abnormal Bleeding

The types of treatment for abnormal vaginal bleeding are based on many factors, such as

cause of bleeding,
age and
whether you want to have a child.

Most cases of abnormal vaginal bleeding can be treated with medications, except for a few cases that may require surgery. The goal of treatment is to either treat the underlying cause or manage symptoms and improve the patient's quality of life. Working closely with your Dr Crawford to create a treatment plan tailored to your needs and circumstances is crucial.

Medications For Abnormal Bleeding

Several medications can be used to treat abnormal bleeding, depending on the underlying cause. Dr Crawford may prescribe medications that include:

Birth control pills, patches, or vaginal rings: These medications contain a combination of oestrogen and progestin, which can regulate menstrual bleeding and balance hormones in the body.
Progestin therapy: Progestin-only therapy, such as the Progesterone implant or a progestin-releasing IUD, can help regulate menstrual bleeding.
GnRH agonists: This medication temporarily lowers oestrogen and progesterone levels, which stops menstrual bleeding.
Non-steroidal anti-inflammatory drugs (NSAIDs): can manage menstrual cramps and heavy bleeding.
Tranexamic acid: This medication can help reduce heavy menstrual bleeding by slowing down the breakdown of blood clots.
Blood-clotting medications: For bleeding disorders, treatments with medication help the blood clot more effectively.
Antibiotics: For an infection, it will be treated with antibiotics.

Surgical Treatment For Abnormal Bleeding

Dr Crawford will recommend surgical treatment depending on the cause of the bleeding. Some of the surgical options include:

Hysteroscopy: is a procedure in which a thin, lighted tube is inserted into the uterus through the cervix to diagnose or treat abnormal bleeding.
Endometrial ablation: This procedure destroys the uterus lining to reduce or stop heavy menstrual bleeding.
Myomectomy: This surgery removes fibroids, which are benign growths in the uterus.
Hysterectomy: In severe cases or if no other options have worked, a hysterectomy (removal of the uterus) may be recommended to treat abnormal bleeding.
Laparoscopic surgery: can treat endometriosis, where the tissue that lines the uterus grows outside of it.

Surgical treatment should be considered only after other options have been tried and failed or if a serious condition like cancer causes bleeding. In complex surgical cases, Dr Crawford may involve another Gynaecologist, with sub-specialization in the relevant treatment. Along with these treatments, you can take good care of yourself by eating a well-balanced diet, exercising, and getting a proper amount of sleep.