Abnormal Menstrual Bleeding

What is Abnormal Menstrual Bleeding?

Abnormal menstrual bleeding also called abnormal or irregular periods, is when a woman experiences bleeding that differs from her normal menstrual cycle.

In general, menstrual bleeding:

• Occurs every 28 days
• Lasts about 5 days
• Involves the loss of 2 to 8 tablespoons of blood

All women are different and many variations in the timing, duration and amount of bleeding are considered normal.

However, in some cases, differences or changes in your menstrual bleeding are considered abnormal and may be a sign of another condition.

Examples of abnormal menstrual bleeding include:

• Spotting or bleeding between periods
• Bleeding after sex
• Unusually heavy or unusually light flow during periods
• Periods that are longer or shorter than normal
• Menstrual cycles that occur less or more frequently than normal
• Bleeding after menopause
• Missing periods

There are many possible causes of abnormal menstrual bleeding, including:

• Menstrual dysfunction
• Change in hormone levels
• Tumors, polyps or fibroids of the vagina, cervix, uterus or fallopian tubes
• Endometrial hyperplasia (thickening/buildup of the lining of the uterus
• Cervical disorders
• Cancer
• Sexually transmitted diseases
• Vaginal injury
• Pregnancy complications
• Use of an intrauterine device (IUD) for birth control
• Certain medications
• Polycystic ovary syndrome
• Birth control pills

Diagnosing the cause of abnormal menstrual bleeding starts with a thorough physical exam and medical history, including detailed information on your menstrual bleeding. Keep a record of when your period begins and ends, the amount of flow, other instances of bleeding, and any other symptoms.

Depending on the suspected cause, other testing may include:

• Blood work and urine test
• Ultrasound
• Endometrial biopsy – Involves taking a tiny sample of tissue from your uterus for testing.
• Laparoscopy – Looks for abnormalities of the reproductive organs using a tiny lighted instrument inserted through a small incision in the abdomen.
• Diagnostic hysteroscopy – An office procedure that uses a small, lighted telescope (hysteroscope) inserted through the vagina and cervix to examine inside the uterus.

Treatment of abnormal menstrual bleeding will depend on the cause, patient's age and other factors. Treatments can range from lifestyle changes to medical options to surgery.

Treatment options include:

Medical treatment. Using birth control pills or hormones to control bleeding

Surgical treatment. To remove growths such as polyps or fibroids that can cause abnormal bleeding. Surgery can often be performed using hysteroscopy, a minimally invasive approach to examine and treat the inside of the uterus.

Additional options when other forms of treatment have failed or aren't viable include endometrial ablation (to destroy the lining of the uterus) and hysterectomy (surgery to remove the uterus).

Abnormal uterine bleeding is bleeding that is different from a woman's normal menstrual cycle, unrelated to menstruation, or unusual for her age. It is one of the most common health issues for women.

Examples of abnormal uterine bleeding include:

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

Abnormal uterine bleeding can have many causes and can occur at any age. It may be a sign of a gynecologic condition or other medical problem. Possible causes include:

• Pregnancy or ectopic pregnancy
• Miscarriage
• Hormonal imbalance
• Problems linked to birth control methods
• Infection of the uterus or cervix
• Fibroids or polyps
• Problems with blood clotting
• Cancer of the uterus, cervix, or vagina
• Chronic medical conditions such as thyroid problems and diabetes
• Endometrial hyperplasia

Diagnosing the cause of abnormal uterine bleeding starts with a complete medical history, including detailed information on your normal menstrual cycle and the abnormal bleeding you are experiencing. Keep a record of the dates, duration, and amount of abnormal bleeding.

A physical exam, pelvic exam, and Pap smear should also be conducted.

Additional tests may include:

• Screening for STDs (sexually transmitted diseases)
• Blood tests
• Ultrasound - To take images of your pelvic organs.
• Endometrial biopsy - To obtain and analyze a tissue sample from the lining of your uterus.
• Sonohysterography - An ultrasound using sterile saline to expand the uterine cavity for easier imaging.
• Hysteroscopy - An office procedure using a small, lighted telescope (hysteroscope) inserted through the vagina and cervix to see the inside of the uterus.
• Hysterosalpingography - An x-ray is taken after injecting dye into the uterus and fallopian tubes.
• Dilation and curettage (D&C) - To obtain tissue from the lining of the uterus for examination under a microscope.
• Laparoscopy - A thin, lighted tube with a camera on the end (laparoscope) is inserted into the abdomen through a small incision, allowing the surgeon to see inside the abdomen.

Treatment of abnormal uterine bleeding depends on the cause, patient's age, and other factors. Treatment options include:

• Wait and watch approach
• Medical treatment - Using hormones such as oral contraceptives, estrogen and progestins, and other medications.
• Surgical treatment - To remove growths such as polyps or fibroids that can cause bleeding. Surgery can often be performed using hysteroscopy, a minimally invasive approach to examine and treat areas of concern inside the uterus.

Additional options when other forms of treatment have failed or aren't viable include endometrial ablation (to destroy the lining of the uterus) and hysterectomy (surgery to remove the uterus).

To schedule an appointment with a Baylor Medicine physician specializing in abnormal uterine bleeding, call the department of Obstetrics and Gynecology at 832-826-7500.

What is Amenorrhea?

Amenorrhea, also known as missed periods, is the absence of a normal monthly period or menstrual cycle.

There are two types of amenorrhea:

Primary amenorrhea is when a girl has never had a period. Most girls start their period by the time they are 16.

Secondary amenorrhea is when a girl who has had periods stops having them for several months. This is the most common type of amenorrhea.

• Possible causes include:
• Pregnancy  
• Eating disorders and weight changes  
• Excess exercise (also called athletic amenorrhea)
• Polycystic ovary syndrome (PCOS) – the ovaries produce excessive amounts of male hormones, causing irregular periods and other symptoms
• Premature ovarian insufficiency (POI) – the ovaries do not make enough estrogen to cause periods 
• Obesity 
• Endocrine problems 
• Chronic illness such as Crohn's disease, cystic fibrosis, sickle disease, lupus and diabetes 
• Certain medications 
• Stress
• Depression
• Congenital defect of the reproductive tract 

Diagnosis starts with a thorough medical history and physical exam, and possibly a pelvic exam.

Additional testing may include:

• Pregnancy test
• Blood tests
• Progestin challenge test (to check for lack of estrogen)
• Imaging tests
• Laparoscopy or hysteroscopy, to view internal organs

Treatment for amenorrhea will depend on the cause and may include lifestyle changes and medical treatment, including:

• Changes in your exercise habits 
• Changes in your diet
• Stress management
• Hormone therapy or other medications