Abnormal Uterine Bleeding

Women vary greatly in their menstrual cycles: what is normal for one may be abnormal for another. Adolescents in particular may have tremendous variability in their cycles until their hormone levels balance out after several years of menstruation. Doctors define abnormal uterine bleeding as:

• having a period less often than every 35 days
• having a period more often than every 21 days
• bleeding or spotting between periods
• bleeding very heavily (menorrhagia), that is, saturating a pad or tampon hourly for more than several hours

Causes of Abnormal Bleeding
Many lifestyle factors can disrupt your normal cycle and cause you to miss periods. These include stress, being overweight, losing weight too quickly, excessive exercise, and taking certain medications. Additionally, an abnormality of the thyroid gland or other hormonal imbalances may cause less frequent periods. All of these can be addressed by correcting the underlying problem, and in some cases through treatment with hormones.

On the other hand, very heavy abnormal bleeding may have a medical cause, such as:

• Adenomyosis
• Endometriosis
• Fibroids
• Hyperplasia
• Polyps
• Ovarian cysts
• Von Willebrand’s disease

Women who are approaching menopause often experience irregular periods, usually lighter and less frequent. However, if heavy or prolonged bleeding or spotting between periods occurs, you should see your doctor. Risk of hyperplasia, polyps, pre-cancer and cancer of the uterus increase during this time of life, and all of them can be successfully treated. In the unlikely event of uterine cancer, (2 out of 1,000 women over age 50), remember the rule of thumb that applies to all cancers: the earlier caught, the easier cured.

Treatment Options
The treatment your doctor recommends will depend upon the cause of your abnormal bleeding. If the cause is related to missed ovulation or an ovarian cyst, very often it can be treated simply with birth control pills. These provide regular and consistent amounts of estrogen and/or medication that acts like progesterone to the body and help regulate your monthly cycles.

Another option is a new type of intrauterine device (IUD) that releases small amounts of a progesterone-like hormone continuously directly to the uterine lining cells. This has the effect of thinning the lining of the uterus and reducing menstrual blood flow by up to 80%.

Some over-the-counter anti-inflammatory medications such as ibuprofen and naproxen are effective in reducing bleeding by constricting the blood vessels.

Surgical options for most noncancerous gynecological conditions include a number of minimally invasive techniques that correct such problems as fibroids and polyps without causing undue disruption of one’s life and routine. These include laparoscopic surgery, D&C, endometrial ablation, hysteroscopy and focused ultrasound.

The appropriate treatment, of course, will depend on your medical condition as well as other factors – your age, whether or not you wish to have children, your state of health, the risks of recurrence, etc. – and should be discussed with your doctor. It is always a good idea to try the least invasive options before resorting to major surgery.

References

1. American College of Obstetricians and Gynecologists. Gynecological Problems: Abnormal Uterine Bleeding. 2003. www.acog.org/publications/patient_education.pdf/bp086.cfm.
2. American Society for Reproductive Medicine. Abnormal Uterine Bleeding: A Guide for Patients. Patient Information Series 1996. www.asrm.org/Patients/patientbooklets/abnormalbleeding.pdf.
3. National Heart Lung and Blood Institute. Von Willebrand’s Disease. National Heart Lung and Blood Institute. 2007.
4. Parker WH. A Gynecologist’s Second Opinion. (c) 2003; A Plume Book; Published by the Penguin Group, New York, NY.