Abnormal bleeding includes bleeding that is prolonged (longer than a woman’s normal menstrual period), too frequent (less than 21 days from the first day of one episode of bleeding to the first day of the next) or heavier than usual (or requiring more than a pad every hour during the heaviest time). There are many reasons for abnormal uterine bleeding and these can be sub-divided into two main groups: hormonal imbalance causing ovulatory problems and abnormalities of the vagina, cervix or uterus. The latter group of abnormalities include infections, polyps, uterine fibroids and cancer.
Abnormalities of the vagina and cervix
Infections or other conditions of the vagina and cervix sometimes can cause bleeding, though usually this is light and may be associated with intercourse. Post-menopausal women sometimes can have thinning of the vaginal walls that can lead to light bleeding. Abnormalities of the cervix, including cervical cancer, also can cause bleeding. These conditions can be diagnosed by physical examination and office tests.
These are benign growths in the uterine lining that can lead to irregular uterine bleeding. They can be removed by hysteroscopy, a procedure during which a slender “telescope” is inserted through the vagina and cervix into the uterine cavity to allow examination of the cavity and removal of the polyps.
In women who have experienced menopause, abnormal bleeding can sometimes be a sign of endometrial cancer, or cancer of the lining of the uterus. This usually can be diagnosed by tests done as day-surgery procedure, including an endometrial biopsy in which some cells are removed from the endometrium. Endometrial cancer can be treated with surgery if diagnosed early.
A medical history and gynaecologic examination are useful in identifying the cause of abnormal uterine bleeding. Usually, hormonal tests and ultrasound examination are needed. Tests for infections may be indicated depending on the clinical findings. Hysteroscopy, a procedure during which a small viewing instrument is placed into the uterine cavity in order to examine the cavity, is often helpful. Hysteroscopy is usually coupled with curettage whereby a small amount of tissue can be removed from the uterine cavity to assist in making a diagnosis.
Definitive treatment depends on the cause of the abnormal uterine bleeding. Abnormal bleeding due to hormonal imbalance may be treated with hormones such as oral contraceptive pills. Sometimes, the polyp, fibroid or uterus may need to be surgically removed. Early diagnosis and treatment for cancers of the uterus and cervix are usually curative.