Definition & Overview
Heavy or irregular vaginal bleeding occurs when blood flows from the vagina in-between regular menstrual periods, if there is excessive blood flow, if a scheduled menstruation period is missed, or if menstruation should not be present at all. Abnormal bleeding is often a symptom of an underlying medical condition and specialists carry out various examinations to determine the exact cause to provide the correct form of treatment. Blood flowing from the vagina is a normal occurrence and happens once every menstrual cycle, which is usually every four weeks. Menstruation is a result of hormonal changes. The ovaries produce the female hormones that not only control the female characteristics but also regulate the menstrual cycle. On day one of the menstrual cycle, the inner lining of the uterus undergoes a shedding process resulting in blood flowing from the vagina. Regular menstrual cycles can be predicted to the very day that blood will begin to appear. If blood begins to flow in the middle of the cycle or before the cycle should begin, or if a woman misses her menstruation period without being pregnant, the condition is called irregular bleeding. In the same manner, the amount of blood is about the same every menstruation. If the amount is more than expected, which is usually between 2 to 8 tablespoons per cycle, it is referred to as heavy or excessive bleeding.
Cause of Condition
Heavy or excessive bleeding can be caused by endometrial fibroids and polyps, adenomyosis, intrauterine devices, hypothyroidism, systemic lupus erythematosus, blood clotting disorders, and certain medications that can interfere with the blood clotting process. Endometrial cancer can also cause heavy vaginal bleeding although it is not a common condition. Meanwhile, irregular vaginal bleeding, specifically menstruation that occurs too often, could be due to endometritis, oral contraceptives, or when a woman is near the menopausal period. If the amount of blood is significantly less compared to the usual, the most probable causes are the use of hormonal birth control methods or intrauterine devices. It is important to note that when a woman is ovulating, it is normal for small amounts of blood to flow from the vagina in between menstrual periods. This condition is called spotting. If a woman has reached the menopausal period but still experiences bleeding, she may have one or more of the following conditions: * Anorexia * Chronic medical illness * Significant stress * Polycystic ovarian syndrome
Endometrial cancer can also cause the condition, but this is less common than the others. Heavy or irregular vaginal bleeding can also happen after sexual intercourse. Some of the most common causes are an injury to the vaginal wall, infections to include sexually transmitted diseases, low levels of estrogen, tumors, or polyps. Vaginal bleeding can also occur during pregnancy. Although many women associate vaginal bleeding during pregnancy with some problems, this isn’t always the case. In fact, around 30% of pregnant women experience some degree of bleeding during this period. In some cases, bleeding can be normal, such as during the first two weeks into the pregnancy. However, there are cases when bleeding does indicate a problem. Therefore, it’s imperative that a pregnant woman experiencing vaginal bleeding to seek medical consultation to determine the exact cause. Possible causes could be a miscarriage, ectopic pregnancy, cervical infection, or even premature labor. Certain types of medications may also cause vaginal bleeding during pregnancy, which is why pregnant women are always advised to avoid taking medications as much as possible.
Heavy or irregular vaginal bleeding can be accompanied by several other symptoms, such as eating disorders, a significant amount of pain, infertility, acne, excessive hair growth, pain during sexual intercourse, fever, nausea, and other symptoms that normally accompany an infection. However, in some cases, abnormal vaginal bleeding may not be accompanied by other symptoms. For instance, a woman may notice spots of blood in her underwear and not notice any other symptoms. However, this does not necessarily mean that the condition is normal. It’s best to consult a doctor as soon as possible so that the condition can be evaluated and treatment provided if necessary.
Who to See and Types of Treatment Available
The first person to see in the case of heavy or irregular bleeding is the family doctor. If the doctor believes that the problem requires the expertise of a specialist, the patient will be referred to a consultant, such as an obstetrician or gynecologist. Prior to making a referral to a specialist, the doctor will review the patient’s medical history and perform several exams to evaluate her physical condition. The patient will also be evaluated for pregnancy. If the doctor believes that the condition does not require the services of a specialist, treatment will be provided. If the patient is referred to a specialist for consultation, the same tests will be ordered to determine the cause of the condition. These include a thorough physical exam and a detailed review of the patient’s medical history. The history of diseases in the family will also be reviewed if the specialist suspects that the cause is hereditary. Depending on the initial results, other tests may also be ordered such as: * Cervical cultures, if sexually transmitted disease is suspected * Blood test to check ovarian and thyroid function * Cervical biopsy * Pap smear * Endometrial biopsy * Pelvic ultrasound * Hysteroscopy
After the specialist makes a diagnosis, a treatment plan will be introduced. Common treatment methods for heavy or irregular bleeding include: * Endometrial ablation * Progestin therapy using levonorgestrel intrauterine device * Contraceptives containing a combination of estrogen and progesterone * Hysterectomy without cervical preservation
If tests confirmed that the cause is cancer, the patient would be referred to an oncologist or a cancer specialist, who will perform a variety of tests to determine the type of cancer and how far it has spread. Treatment for this condition includes chemotherapy, radiation therapy, other medications, or surgery if required.
Reference * Lobo RA. Abnormal uterine bleeding: ovulatory and anovulatory dysfunctional uterine bleeding, management of acute and chronic excessive bleeding. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap 37. * Bulun SE. The physiology and pathology of the female reproductive axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 17.