Women of any age can experience abnormal bleeding – that is, bleeding that is heavy, lasts long periods of time, or occurs outside of regular menstrual cycles. When we say abnormal bleeding, the textbooks define it as blood loss from the uterus in excess of 2.8 ounces, or about a third of a cup over a few days. But who is actually measuring their blood loss? For practicality, abnormal bleeding is bleeding that interferes with regular activities.
Many women also deal with irregular periods that come so irregularly that they feel they are bleeding all the time or so infrequently that the bleed only once every 3-4 months. Though fewer periods may be desirable, it needs to be evaluated. Abnormal bleeding or spotting often happens:
- After menopause
- After sex
- Between periods
Abnormal bleeding is not “normal,” and you don’t have to live with it. Help is available, whether you’re a teen who’s just starting to deal with abnormal bleeding or a woman in perimenopause who’s struggled for years. Let’s discuss the primary causes of abnormal bleeding, some common treatment options, and which associated conditions can exist.
What causes abnormal bleeding?To diagnose the cause, we first must determine the source of the bleeding. Is it coming from the uterus, the cervix, or the vagina? Sometimes, bleeding that is thought to be coming from the vagina may actually be from the bladder or the bowels. Next, we discuss the patient’s symptoms. Then we perform a physical examination, which will generally include a pelvic exam to check the cervix and vagina as well as all potential sources of bleeding.
One of the most common causes of bleeding and discharge is cervicitis, an infection that often is triggered by sex. It causes inflammation and irritation of the cervix, which is located at the lower end of the uterus. Often, we will also evaluate the cervix for cancerous and pre-cancerous lesions of the cervix by performing a pap test.
However, abnormal bleeding can be the result of many conditions, many of the uterus (or the womb). To identify a condition, we follow the acronym PALM-COEIN (pronounced palm coin) for the primary conditions of the uterus that lead to abnormal bleeding:
- Polyps: growths, or small clumps of cells, that form when cells in the lining of the uterus overgrow
- Adenomyosis: the result of tissue that normally lines the uterus growing into the uterine wall
- Leiomyoma: benign tumors in the uterus, often called fibroids
- Malignancy and hyperplasia: when the lining of the uterus (endometrium) becomes too thick
- Coagulopathy: when the body’s ability to clot is worsened, usually due to reduced levels or absence of blood-clotting proteins
- Ovulatory dysfunction: a very common cause of abnormal bleeding and occurs when ovulation is abnormal, irregular, or absent
- Endometrial: abnormal functioning of endometrial tissue
- Iatrogenic: when bleeding could be the result of birth control, other hormonal drugs, or other medications
- Not otherwise classified: when doctors can’t discern one specific cause for bleeding issues
Bleeding that interferes with life is not “normal,” and you don’t have to live with it. Help is available, whether you’re a teen who’s just starting to deal with abnormal bleeding or a woman in perimenopause who’s struggled for years.
Treating abnormal bleedingMany conditions can be treated with medication. If there is an infection, antibiotics will be called for. For many of the uterine sources of bleeding hormone treatments such as birth control pills, progesterone pills, or intrauterine devices (IUDs) that help regulate and lighten periods.
When conservative treatment doesn’t work or for uterine growth conditions such as polyps or leiomyoma, patients might require minimally invasive surgery to remove abnormal tissue. In severe cases, and generally only when women are done with fertility, the doctor might recommend a hysterectomy to remove the uterus for a definitive treatment. However, women should never feel pressured into hysterectomy as their only option since we have many treatment options available today.
What can happen if abnormal bleeding is left untreated?Excessive blood loss causes some women to develop iron-deficiency anemia. That’s when blood lacks healthy red blood cells. This condition can cause dizziness, fatigue, and shortness of breath.
In some cases, untreated abnormal bleeding that’s the result of ovulatory dysfunction, which causes women to have irregular cycles, can predispose women to precancerous endometrial conditions such as hyperplasia, which occurs when the lining of the uterus thickens and can cause uterine cancer. So even if you might like having only three to four periods per year, this isn’t normal and should be evaluated.
I often see women who just feel a “lack of energy” and we get to talking about her period and find out she’s been living with abnormal bleeding all her life and just never knew it was “abnormal.” It’s amazing to see women get their life and energy back through evaluation and the right treatments.
Women should seek treatment for abnormal bleeding. Not only can women’s health specialists help enhance quality of life, we also can ensure a healthier future by managing underlying conditions. To schedule an appointment, call 214-645-8300 or request an appointment online.