Abnormal vaginal bleeding

Abnormal vaginal bleeding is a flow of blood from the vagina that occurs either at the wrong time or in inappropriate amounts. Normal ovulation is necessary for regular menstrual periods.

What conditions cause abnormal vaginal bleeding in women who are ovulating regularly?

  • Excessively heavy menstrual period
    • Non-cancerous causes: uterine fibroids or polyps, intrauterine devices, blood clotting disorders and certain medications, especially those that interfere with blood clotting.
    • Cancerous Causes: It can be a sign of endometrial cancer or the precancerous endometrial hyperplasia (thickened endometrial lining), it is more common above the age of 40.
  • Menstrual periods that is too frequent
    • Pelvic inflammatory disease or Endometriosis. Sometimes, the cause is unclear and the woman is said to have dysfunctional uterine bleeding.
  • Menstrual periods at irregular intervals
    • benign growths in the cervix, such as cervical polyps, infections of the uterus and use of birth control pills. Perimenopause (the time period approaching the menopausal transition) is often characterized by irregular menstrual cycles
  • Spotting between menstrual periods
    • Women who are ovulating normally can experience spotting between menstrual periods. Hormonal birth control methods as well as IUD may sometimes lead to spotting between periods.
    • Psychological stress, certain medications such as anticoagulant drugs, and fluctuations in hormone levels may all be causes of light bleeding between periods.

What conditions cause abnormal vaginal bleeding in women who are NOT ovulating?

Anything interfering with normal ovulation can cause abnormal vaginal bleeding, examples are chronic medical illness or severe medical or emotional stress, malfunction of a part of the brain-hypothalamus, Anorexia nervosa(an eating disorder associated with excessive thinness) or Polycystic ovarian syndrome(hormonal problem) may cause anovulation and irregular periods.

What conditions cause abnormal vaginal bleeding after menopause?

Any vaginal bleeding is considered abnormal and doctor’s consultation should be immediate to rule out the serious causes like endometrial cancer or the precancerous endometrial hyperplasia (thickening of the uterine lining).

What causes vaginal bleeding during or after sexual intercourse?

Injuries to the vaginal wall or vaginal opening during intercourse.  Infections or Lowered estrogen levels in peri-menopausal or postmenopausal women may cause the lining of the vagina to become thinned and easily inflamed or infected. Anatomical lesions, such as tumors or polyps on the cervix or vaginal wall may lead to vaginal bleeding during or after intercourse.

What diagnostic tests are used to evaluate abnormal vaginal bleeding?

Diagnosis includes a medical history and physical exam. During the pelvic examination, the physician attempts to detect cervical polyps or any unusual masses in the uterus or ovaries.  In addition some diagnostic procedures may include the following:  Tests should be performed to know the hormonal status of the woman, pregnancy test as routine if the woman is pre menopausal. Pap test to rule out cervical cancer, culture of cervical and vaginal discharges to rule out infections. Blood tests to evaluate thyroid function, liver function, or kidney function abnormalities. A pelvic ultrasound is also performed. An endometrial biopsy is also beneficial.

How is abnormal vaginal bleeding treated?

Treatment for irregular vaginal bleeding depends on the underlying cause.

  • If the cause of the bleeding is lack of ovulation, doctors may prescribe either progesterone to be taken at regular intervals, or an oral contraceptive, which contains progesterone, to achieve a proper hormonal balance
  • If the cause of irregular vaginal bleeding is a precancerous change in the lining of the uterus, progesterone medications may be prescribed to reduce the buildup of precancerous uterine lining tissues in an attempt to avoid surgery.
  • When a woman has been without menses for less than six months and is bleeding irregularly, the cause may be menopausal transition. During this transition, a woman is sometimes offered an oral contraceptive to establish a more regular bleeding pattern, to provide contraception until she completes menopause, and to relieve hot flashes.
  • Benign growths are removed surgically to control bleeding.
  • If the cause of bleeding is infection, antibiotics are necessary.
  • If bleeding is excessive and cannot be controlled by medication, a surgical procedure called dilation and curettage (D&C) may be necessary.
  • Occasionally, a hysterectomy is necessary when hormonal medications cannot control excessive bleeding. However, unless the cause is pre-cancerous or cancerous, this surgery should only be an option after other solutions have been tried.

Author: DrAshrafSabry

Fertility, Obstetrics & Gynecology Consultant.