Women have menstrual cycles starting from the age of about 11-12 years up to about 50 years of age. In this time span, a woman is likely to have a few episodes of bleeding that are not her usual cycle. If this abnormality is a persistent occurrence, then you should be concerned about it and consult a gynaecologist. Some things that you should keep a lookout for include an increase in the number of days of bleeding, heavy bleeding with clots, associated pain, or irregular bleeding. While normal menstrual bleeding can last up to 7 days, abnormal bleeding happens when the menstrual period is not regular (longer than usual), is heavier, or the pattern of bleeding has undergone changes.
What is a Normal Menstrual Cycle?
A normal cycle occurs every 28-35 days, lasts for a maximum of 7-8 days, and is not associated with major pain or clots. During the menstrual cycle, two hormones, oestrogen and progesterone act on the lining (endometrium) of the uterus and cause it to grow. At the end of the cycle, the endometrium sheds and is seen as menstrual bleeding.
The menstrual cycle begins with the first day of bleeding of one period (referred to as D1) and ends with the first day of the next period. An average cycle lasts for approximately 28 days but can be shorter or longer for different people. If your cycle is longer than 35 days or shorter than 21 days, it is considered to be abnormal.
About Abnormal Uterine Bleeding
There are certain conditions that are referred to as abnormal uterine bleeding, including:
1) Bleeding between periods
2) Bleeding after sex
3) Spotting at any time during the menstrual cycle
4) Heavier or longer than usual bleeding
5) Absence of menstrual periods for 3 normal cycles or for 6 months
Abnormal bleeding is something that can occur at any age. There are even times in a woman’s life when it is common for their periods to be somewhat irregular. Often, in the first few years when a girl starts having her periods, from the ages of 9 to 16, periods are not very regular. Starting as early as at 35 years of age and even more commonly when a woman nears menopause at about 50 years of age, it is normal for the menstrual cycle of a women to become shorter. It is also normal for a woman to skip her periods or for the bleeding to become lighter. However, if the bleeding gets heavier, that is when you should get it checked.
Causes of Abnormal Bleeding
There are many causes that can lead to abnormal bleeding. While some of these problems are not very serious and can be treated by counselling or medication, others can be a cause for concern. Abnormal uterine bleeding can happen if the body is not making enough of a hormone, because of problems linked to birth control methods like intrauterine devices or oral contractive pills, pregnancy-related causes, because of tumours in the uterus, or because of cancer. So, regardless of the causes, you should get yourself checked whenever you experience abnormal bleeding.
Diagnosis of Abnormal Bleeding
To diagnose why you have abnormal uterine bleeding, a detailed history with the physical examination is essential. Additionally, your doctor may ask you to undergo a few blood tests and an ultrasound examination to rule out any problems in the problems in the uterus. It can be very helpful to maintain a menstrual calendar as it would give you a better insight into the problem if you can view the pattern for about 4-6 months. A thyroid test may also be suggested as abnormality in thyroid hormone secretion is also one of the causes of abnormal bleeding.
Beyond these, a hysteroscopy (endoscopic evaluation) of the uterine cavity or a D&C may be needed to diagnose the issue. Sometimes, a laparoscopy may be prescribed in order to rule out other causes.
Treatment for Abnormal Bleeding
Treatment for abnormal bleeding can depend on many factors, including its cause, your age, the severity of bleeding, and whether you desire to have any future pregnancies. The condition can be treated with hormones or other medication, or surgery may be needed. In case you are prescribed medication, it will take a few cycles to understand whether the medication is working. Non-hormonal medication that helps reduce pain and bleeding when taken during the periods is generally the first line of treatment and if they help, you may be asked to take them during your periods for a few cycles. Hormones are other medication that may be needed if there is a suggestion of a hormonal imbalance or deficiency; for example, progesterone can help prevent and treat endometrial hyperplasia. However, it may take a few months for the hormones to control the bleeding and your periods may be heavier for the first few months. However, they will lighten over time.
Surgery
Some women who suffer from abnormal uterine bleeding may require surgical treatment to remove growths (like fibroids or polyps) that are responsible for the bleeding. Often, this can be done with hysteroscopy. However, sometimes other surgery may also be required. Endometrial ablation is also used to treat abnormal uterine bleeding. This treatment uses heat to destroy the lining of the uterus and is meant to reduce or stop the bleeding permanently. Before treatment is performed, an endometrial biopsy is needed. You should also know that a woman may not be able to get pregnant after ablation.
Hysterectomy, the removal of the uterus, is another procedure that can be used for the treatment of abnormal bleeding. This may be done when other forms of treatments have failed or are not an option. Hysterectomy is major surgery and following this procedure a woman will no longer have periods or be able to get pregnant.
If you notice irregular cycles that persist for a long time, it is better to check with a gynaecologist. Abnormal bleeding has a number of causes and there is no actual way of knowing why your bleeding is abnormal till a gynaecologist is allowed to make an assessment of your condition. Once the cause is found, abnormal uterine bleeding can often be treated with success.
