Vaginal Bleeding

Menstruation, or period, is a woman's monthly bleeding. Abnormal vaginal bleeding is different from normal menstrual periods. It could be bleeding that is between periods, lasts several weeks, or happens before puberty or after menopause. Causes can include: - Uterine fibroids or polyps - Hormone problems - Hormone pills, such as birth control pills and menopausal hormone therapy - Thyroid problems - Cancer of the cervix, ovaries, uterus or vagina Bleeding during pregnancy can have several different causes. It is not always a serious problem, but to be safe you should always contact your healthcare provider. Pelvic exams, blood tests and other procedures can help your healthcare provider diagnose the problem. Treatment depends on the cause.

Introduction

Menstruation is a woman’s monthly bleeding, also known as a period. Abnormal vaginal bleeding is different from normal menstrual periods. It is a common problem faced by women. Abnormal vaginal bleeding could be bleeding that is between periods or bleeding that lasts several weeks. It is also abnormal if the bleeding happens before puberty or after menopause. This program will help you understand abnormal vaginal bleeding. It discusses causes, diagnosis, and treatments.

Female Reproductive System

The female reproductive organs include:

• The ovaries
• The fallopian tubes
• The uterus or the womb
• The vagina

The female reproductive organs are located in the pelvis, between the urinary bladder and the rectum. The ovaries are glands with 2 main functions:

1. The production of hormones, such as estrogen and progesterone.
2. Ovulation, which is the release of eggs needed for reproduction.

Estrogen and progesterone prepare the inner lining of the uterus, also known as the womb, in case a pregnancy takes place. These hormones also regulate when eggs are released. When an egg is released, it goes down the fallopian tube and into the uterus, where it may or may not be fertilized by a sperm. Fertilization is when a sperm cell from a man merges with an egg from the woman. If fertilized, the egg becomes implanted in the uterus where the fetus grows. If not fertilized, the egg and the inner lining of the uterus are discharged to the outside of the body through the cervix and the vagina during the menstrual period. The menstrual cycle usually lasts 28 days. The levels of estrogen and progesterone increase before and after ovulation. If the egg is not fertilized, hormone levels decrease and menstruation begins. Estrogen and progesterone are only two of the many hormones that control the menstrual cycle.

Vaginal Bleeding

Abnormal vaginal bleeding is any bleeding not related to a woman’s normal period. There are many times when vaginal bleeding is considered abnormal. Bleeding or spotting between periods or after sex is considered abnormal vaginal bleeding. Bleeding before puberty or after menopause is also considered abnormal. Very heavy bleeding at any time is also considered abnormal. It is also abnormal for your period to last several weeks. Very heavy bleeding is bleeding that fills up a pad or tampon within an hour or two. It is abnormal for your menstrual cycles to be longer than 35 days or shorter than 21 days. Not having your period for 3 to 6 months is abnormal as well. Abnormal vaginal bleeding can happen to women at any age. Some irregularity may be normal for girls just starting their periods and women who are near menopause.

Causes

Abnormal vaginal bleeding has many possible causes. The following slides look at some common causes of abnormal vaginal bleeding. Uterine fibroids or polyps are abnormal growths in the uterus. They are noncancerous. Sometimes uterine fibroids or polyps can cause heavy bleeding or bleeding that lasts several weeks. Hormone problems may cause abnormal vaginal bleeding. Not having enough or having too much of certain hormones can result in bleeding. Hormone pills may cause an imbalance in hormones that regulate the menstrual cycle. This may cause bleeding that is not normal. Examples of hormone pills include birth control pills and menopausal hormone therapy. Like hormone pills, thyroid problems may also cause an imbalance in hormones that regulate the menstrual cycle. Not having the right amount of certain hormones may cause abnormal bleeding. Certain types of cancer may also cause abnormal vaginal bleeding. These may include cancer of the cervix, ovaries, uterus or vagina. Abnormal vaginal bleeding during pregnancy can have several different causes. It is not always a serious problem. However, to be safe you should always contact your healthcare provider.

Diagnosis

Your healthcare provider will ask about your symptoms to find the cause of your abnormal vaginal bleeding. He or she will also ask about your personal and family medical history. A physical exam will be done to check for any abnormalities. This may include a pelvic exam. Blood tests may also be done to check blood count and hormone levels. Another test that may be done is an ultrasound. An ultrasound uses sound waves to make a picture of internal organs. An endometrial biopsy is another test that may be done. This test uses a thin tube to remove a sample of tissue from the endometrium. It is examined under a microscope to look for abnormalities. Another test that may be done to diagnose vaginal bleeding is a hysteroscopy. A hysteroscopy uses a thin, lighted tube to view the inner lining of the uterus. Dilation and curettage, or D & C, is a procedure in which the inside of the uterus is scraped using instruments called “curettes.” In order to insert the curettes into the uterus through the cervix, the cervix must be opened up, or “dilated.” The sample is tested for abnormalities. If other tests are unsuccessful, a laparoscopy may be used to find the cause of abnormal vaginal bleeding. During this procedure, a small cut is made near the navel. A thin, lighted tube is inserted into the cut to view the inside of the abdomen.

Treatment

The treatment for abnormal vaginal bleeding depends on the cause. Your age and whether or not you want to have children can also affect how vaginal bleeding is treated. Most women with abnormal vaginal bleeding can be treated with hormone medications. There are different types of hormone medications available. Some examples include:

• Birth control pills
• An IUD that releases hormones
• Hormone injections
• Hormone vaginal creams

Surgery may be needed to treat some causes of vaginal bleeding. Surgery may be used to remove fibroids or polyps that can cause bleeding. Another surgical procedure that may be done to stop heavy vaginal bleeding is endometrial ablation. This procedure is one of many different methods used to destroy a thin layer of the lining of the uterus. A hysterectomy is another possible surgery for vaginal bleeding. It is the surgical removal of the uterus. This may be done if other treatments are not an option or are unsuccessful. A hysterectomy is discussed only if the woman does not want to be pregnant and have children anymore. It is not reversible. Some women may also choose to wait before trying to treat vaginal bleeding. It is possible that vaginal bleeding will go away on its own. Talk to your healthcare provider to see if watching and waiting is an option.

Summary

Abnormal vaginal bleeding can happen to women at any age. It is a common problem faced by women. Abnormal vaginal bleeding is different from normal menstrual periods. It could be bleeding that is between periods or bleeding that lasts several weeks. It is also considered abnormal vaginal bleeding if the bleeding happens before puberty or after menopause. There are many different causes of abnormal vaginal bleeding. Tests may be done to check hormone levels and examine the female reproductive organs in order to determine the cause. If you experience abnormal vaginal bleeding, meet with your healthcare provider to discuss your treatment options.