Abnormal Bleeding

During each menstrual cycle, the endometrium — the lining of the uterus — builds up and then sheds. An average menstrual cycle lasts around 28 days, counting from the first day (day 1) of one period through the last day before beginning the next. However, a normal cycle may range from 23 to 35 days.

Abnormal bleeding is bleeding that lasts longer or is heavier than the usual menstrual bleeding or occurs apart from the usual menstrual bleeding. The following describes abnormal uterine bleeding and explains its causes and treatments.

The Menstrual Cycle

During the menstrual cycle, two hormones made by the ovaries, estrogen and progesterone, cause certain changes in the lining of the uterus. During the pre-ovulatory phase of the cycle, estrogen causes the lining of the uterus to grow and thicken, starting about day 5.

Then in mid-cycle, ovulation (the release of an egg from one of the ovaries) occurs. After ovulation, progesterone begins to be produced and estrogen and progesterone together cause the lining of the uterus to swell and thicken in preparation for the possibility of a pregnancy.

If a sperm meets an egg in the fallopian tube, the two may join in a process called fertilization or conception. The fertilized egg then begins to develop, moves to the uterus, and becomes attached to the lining of the uterus, where it is nourished and continues to develop.

If an egg is not fertilized, it moves from the fallopian tube to the uterus and is shed with the menstrual flow. The amounts of estrogen and progesterone decrease towards the end of the menstrual cycle, and then the lining of the uterus is shed, beginning a menstrual bleed, or “menstrual period.” The beginning of a menstrual bleeding marks the start of a new cycle.

Causes of Unusual Bleeding

For the first few years in adolescence after menstrual cycles begin, they are often irregular. In older women, menstrual cycles usually become more irregular with the approach of menopause (when the ovaries no longer function and menstrual cycles eventually end) and bleeding may become either lighter or heavier.

Irregularity of a woman's cycles is due to infrequent ovulation, which is common during these times of life. Menstrual cycles that persist in being longer than 35 days or shorter than 23 days may not be normal. They should be checked by a doctor.

Abnormal bleeding may be the result of a hormonal imbalance which may or may not be associated with irregular ovulation. Irregular ovulation and hormonal imbalance can be caused by:

• Excessive weight loss
• Excessive weight gain
• Emotional stress
• Heavy exercise
• Physical illness
• Certain medications

Other causes of abnormal or heavy bleeding are:

• Problems with blood clotting
• Infection of the uterus or cervix
• Miscarriage (when a pregnancy is lost before the baby is able to survive outside of the uterus)
• Ectopic pregnancy (pregnancy occurring outside the uterus, most often in one of the fallopian tubes)
• Uterine fibroids (non-cancerous growths that form on the inside of the uterus, on its outer surface, or within the uterine wall itself)
• Abnormal thickening of the lining of the uterus
• Polyps (non-cancerous growths or tumors of the lining of the uterus)
• Cancer of the uterus, cervix, or vagina
• Problems linked to certain birth control methods, such as the intrauterine device (IUD), birth control pills, Depo shots, and Norplant
• Other hormonal problems, such as thyroid disease

Some vaginal bleeding is not from the uterus and may come from other areas, such as a problem in the vagina.

Diagnosis

To diagnose abnormal bleeding, your doctor will ask you about your medical history and will give you a physical exam. It is helpful for you to chart the dates and length of your cycles by using the Creighton Model FertilityCare System. This is an excellent and accurate means of monitoring the abnormal bleeding.

Further medical tests used to diagnose abnormal uterine bleeding will be based on that charting and the symptoms you are having. These may include blood tests of certain hormones, blood tests for anemia, and blood or urine tests for pregnancy. Other tests and procedures that may be needed include the following:

• Endometrial Biopsy removes a small amount of the lining of the uterus which can be examined under a microscope.
• Cultures of the cervix and the vagina may be performed to check for infection.
• Ultrasound may be performed if abnormalities of the uterus are suspected. With ultrasound, sound waves are used to create a picture (sometimes called sonogram) of the pelvic organs.
• Hysteroscopy allows the doctor to view the inside of the uterus directly. A thin, telescope-like instrument (called a hysteroscope) is inserted through the vagina and cervix to view the inside of the uterus.
• Laparoscopy allows the doctor to view the inside of the abdomen directly. In this procedure a slender telescope-like instrument called a laparoscope is inserted through a small cut just below or through the naval.
• Dilation and Currettage (D&C) is a surgical procedure in which the cervix is dilated (stretched) and tissue is gently scraped or suctioned from the lining of the uterus. It gives your doctor a sample of the lining of the uterus which can be examined under a microscope to detect the presence of any tumors. D&C may also be used to attempt to control the bleeding.
• Hysterosalpingography is a special X-ray procedure in which dye is injected into the uterus and fallopian tubes. It can help determine whether the shape and size of the inside of the uterus are normal.

Some of these procedures can be performed in a doctor's office, while others may be done in a hospital with anesthesia.

Treatment

Treatment for abnormal uterine bleeding will be based on the diagnosis. It may involve surgery or taking hormones, iron, or other medicines.

Hormone Therapy

Hormones can be used to give a more normal hormone balance, which will stimulate the uterine lining to bleed on a regular basis. If hormonal therapy is used, it is not necessary to use birth control pills. Natural hormones can be used cooperatively to restore the natural menstrual cycle.

The Creighton Model FertilityCare System is useful for cooperative natural hormonal therapy. After a few cycles, your doctor will be able to judge how well this treatment is working. If you think you might be pregnant, let your doctor know before you start therapy.

Other Drug Therapy

If you have an infection your doctor will prescribe antibiotics. Some drugs, such as ibuprofen, are used to relieve menstrual cramps, may also be helpful for heavy bleeding. Depending on your condition, other drugs might be prescribed.

Surgical Therapy

Some patients with abnormal uterine bleeding can be treated with surgical techniques to remove growths such as polyps or fibroids that are causing the bleeding. Rarely, hysterectomy (surgical removal of the uterus) may be required in women for whom other forms of treatment have not worked.

Finally.....

If you notice that your cycles have become very short (less than 21 days) or the flow has become very long (8 days or more) or very heavy (gushing of blood, large clots, the need for extra protection), see your doctor. If you are past menopause and not taking hormones, any uterine bleeding is abnormal and should be evaluated promptly by your doctor.

By charting your cycles with the Creighton Model FertilityCare System, you will provide your doctor with very important information to diagnose and treat your condition. FertilityCare Medical Consultants are specially trained to use information from your Creighton Model FertilityCare charting to diagnose and treat abnormal uterine bleeding.

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