What Causes Abnormal Menstrual Bleeding? Is There A Solution?

We all know that a normal menstruation occurs every 21 to 35 days and the bleeding is between two and seven days. Abnormal uterine bleeding occurs when the frequency or quantity of uterine bleeding is different from the normal cycle or you are having spotting or bleeding between your menstrual periods.

When is it alarming?

You need to seek medical help when you are:

• Bleeding between periods
• Bleeding after sex
• Spotting anytime in the menstrual cycle
• Bleeding heavier or for more days than normal
• Bleeding after menopause

What causes abnormal uterine bleeding?

Abnormal uterine bleeding is caused by:

• Structural abnormalities of the reproductive system
• Ovulation disorders.
• Women who are post-menopausal should seek prompt care from a doctor for any bleeding, as the causes of bleeding and concerns are different from those in women of reproductive age.

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How will I differentiate between Normal and Abnormal Bleeding?

What exactly happens is a regular monthly menstrual cycle flushes out the endometrial lining, which is a blood-enriched layer of tissue that grows inside uterus every month in an anticipation of a possible pregnancy. If ovulation does not occur, the periods can be delayed, thereby making the lining thicker. For this reason, delayed periods are often heavy ones.

Lighter periods or spotting between periods may represent an endometrial lining that is unstable and leaking either because hormonal levels do not support it or lining may be too thick. Few other factors that can change the bleeding pattern are:

• Hormonal Abnormalities (Thyroid problems, Elevated prolactin hormone)
• Medications
• Excessive exercise or weight loss
• Obesity
• Stress or illness

When Abnormal Uterine Bleeding happens it is primarily due to structural abnormalities of the uterus. The common causes being:

• Benign (Non-Cancerous) lesions of the uterus such as polyps, fibroids (myomas) and adenomyosis (uterine thickening caused by endometrial tissue moving into the outer walls of the uterus).
• Early pregnancy, including miscarriage and ectopic pregnancy, as well as bleeding disorders that affect the ability of the blood to clot normally.
• Lesions of the cervix or vagina (benign and cancerous)
• Chronic infections of the endometrial lining (endometritis)
• Scar tissue (adhesions) in the endometrium
• Use of an intrauterine device (IUD)
• Medications that affect the normal release of oestrogen and progesterone
• Problems like diabetes mellitus
• Disorders of Kidney, Liver, Thyroid gland
• Emotional or physical stress that may affect the pituitary release of FSH and LH

Dysfunctional bleeding occurs more commonly in the first five years after a woman starts menstruating and as she approaches menopause, but it can occur at any time period. So it is important to visit your doctor to rule out any possibility of complications.

How is abnormal uterine bleeding diagnosed?

Your doctor may do various tests to check for the causes of abnormal bleeding patterns. This might include:

• Pregnancy related— Urine or blood tests and Usg.
• Thyroid hormone and prolactin hormone abnormalities — Blood tests
• Menopause related (especially in women in their 40s or 50s) — Blood tests to determine if oestrogen levels are falling, which suggests the beginning stages of menopause and to check on ultrasound the lining of the uterus.  If required an endometrial biopsy or hysteroscopy and directed biopsy.
• Abnormalities of the uterus or ovaries — A transvaginal ultrasound in which a small, rodlike probe is inserted into the vagina to take measurements of the endometrial lining and to check ovarian pathology.

Is there any treatment available?

If the cause of dysfunctional uterine bleeding is another medical condition, treating that condition should restore normal cycles. Otherwise, treatment is based on the cause, the amount of bleeding and the woman’s reproductive goals (whether she wants to have children or not).

Abnormal uterine bleeding is a common problem in women of reproductive age that usually can be corrected with surgery or medication.

Surgery may be able to correct structural causes of abnormal bleeding. If there are no structural causes, medical therapy often can restore regular menstrual cycles. Whatever the cause of abnormal uterine bleeding, there are many treatments available today that can resolve the problem. Patients should speak to their doctors about which medical or surgical options may be best for them.

The individual therapy recommended to you by your doctor will be tailored to the specific cause of abnormal bleeding. Structural abnormalities of the reproductive tract such as fibroids, polyps, or scar tissue often can be treated during hysteroscopy.

What is hysteroscopy and D&C and how does it help in the treatment?

Hysteroscopy is a useful procedure in which a thin telescope-like instrument is placed through the cervix into the uterus which allows visual inspection of the entire uterine cavity. It may allow the physician to identify specific areas of the endometrium that may be biopsied or removed with special instruments. It is a day care minor procedure done in the hospital and you can get back to work the next day.

In some circumstances, a dilation and curettage (D&C) may be recommended to further assess the endometrial tissue. This can be performed at the same time as hysteroscopy in many circumstances. D&C may also be recommended for control of persistent or heavy bleeding in women for whom other methods have been ineffective. Generally, however, hysteroscopy is performed at the same time as the D&C, and D&C is only effective in treating abnormal bleeding in that particular menstrual cycle.

The tissue sample obtained on doing the procedures is sent for histopathological evaluation to rule out abnormalities, hyperplasia and malignancy. If Hyperplasia is found, then it can be treated and followed up closely.

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