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Abnormal Bleeding

A normal menstrual period lasts from 2 to 7 days. The normal cycle patterns can range from 21 to 35 days. When bleeding occurs that is not part of the regular cycle; periods are longer or heavier than normal; occurs between periods; time between periods is longer than normal; or there is an absence of periods, this is called abnormal or irregular uterine bleeding. There are various causes of abnormal bleeding, but the most common is a hormone imbalance. At both ends of the menstrual life of a woman, periods may be irregular. Reasons for abnormal periods can be both normal and abnormal. The most normal reason is pregnancy. Hormone imbalance (not enough or too much of certain hormones) can also be a common reason. This can occur as a result of weight loss or gain; heavy exercise; stress; illness; or certain medications. The most common result of a hormone imbalance is loss of ovulation. If this occurs over a long period of time, a condition called endometrial hyperplasia can occur. Endometrial hyperplasia is the result of constant oestrogen bombardment of the endometrium (the lining of the uterus shed every month with your period). Untreated, endometrial hyperplasia (when the lining of the uterus becomes too thick) can sometimes turn into cancer.

 

There are many reasons for abnormal/irregular periods. The chart below will list the most common reasons, their cause, other symptoms that may occur, diagnostic methods and treatment options. Remember, this is not a replacement for the advice of your care giver, but rather information to help you become aware of your body.

Condition
Cause
Other Symptoms
Diagnosis
Treatment Options
Genetic abnormality in anatomy
Abnormal development of the organs
No periods, heavy periods
Exam, sonogram, hysterosalpingogram (putting dye in the uterus to look at the anatomy of the uterus and tubes)
Reconstrutive Surgery if needed.
Cancer of the uterus, cervix or vagina
Cancer can cause abnormal bleeding cause normal tissues are not present
Heavy bleeding, bleeding with intercourse, bleeding between periods
Exam, biopsy, D&C, other testing specific for the cancer looked for
Surgery specific to the cancer found
Blood clotting problems
Von Willebrand’s Disease, Factor abnormalities, haemophilia
Heavy periods; long periods lasting more than 10 days; clotting
Exam, family history, appropriate blood test
Treatment based on the disease
Uterine fibroids
Growths of smooth muscle non-cancerous tumors in the uterine muscle. These are more common in black women, but are not uncommon in white women. They are very uncommon in Oriental women
Heavy periods, bleeding between cycles, problems with kidneys, increasing abdominal girth, pressure feelings in the lower abdomen, infertility
Exam, sonogram, possibly MRI
Depending on the size and symptoms a myomectomy(Removal of Fibroids), hysterectomy(Removal of womb), can be done.Currently injections are available for short term relief.
Birth Control Pills
Missed pills, newly starting the pill, improper hormone mixture for YOUR body
Brown staining to bright red bleeding in the middle of the cycle; heavy to no periods
Missed pills are obvious; your doctor can make the diagnosis based on the description of what your periods are like compared to before starting the pill
Wait for 2-3 months after starting a new pill; change pills
IUD
Irritation of the lining of the uterus. The uterus can’t stop bleeding after a period
Cramping, heavy clotting
If periods were normal before the IUD was placed, you may need to have it removed. If they return to normal after removal, the IUD was the cause
Remove the IUD
Infections of the uterus or cervix
Some Sexually transmitted diseases
Pain with period, foul smelling discharge, greenish to green-yellow discharge
Exam, cultures, other specific blood test
Appropriate antibiotics and abstinence
Pregnancy
Can be normal; as a result of miscarriage or ectopic (tubal) pregnancy
May have right or left lower abdominal pain; cramping
Pregnancy test, sonogram
If normal – observe; miscarriage may need a D&C; ectopic is a medical emergency and needs IMMEDIATE Surgery
Polycystic ovary disease (syndrome)
No ovulation
Irregular bleeding, irregular periods, infertility, acne , excessive hair growth
Made with examination , lab tests to check hormone levels and Ultrasound to check the ovaries.
Birth control pills, progesterone supplementation every three months; infertility drugs when pregnancy desired

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