Abnormal bleeding is one of the most common symptoms we treat at The Woman’s Health Pavilion. Sometimes this takes the form of periods which come irregularly, or not at all. In other instances, women complain of periods which linger for more than a week, or bleeding which occurs between periods or with intercourse. Most commonly, we treat women with excessively heavy bleeding, requiring frequent pad or tampon changes, and sometimes associated with embarrassing accidents.
To understand abnormal bleeding, women should understand what constitutes normal menstruation. Normal periods occur at 21 to 35 day intervals, with no bleeding in between. Menstrual flow normally lasts no longer than 7 days, including days of spotting. Heavy bleeding with frequent pad changes, flooding, accidents, or the need to double up with a pad and tampon, is never normal. Bleeding, even on your heaviest days, should be no more than moderate.
Symptoms of Abnormal Bleeding
- Bleeding & spotting between periods
- Bleeding after sex
- Wearing protection more than 7 days
- Excessive flow during periods
- Bleeding after menopause
- Periods which are less than 21 days or more than 35 days apart
To a certain extent, these criteria are subjective: How much flow is really “excessive”? To put this in perspective, consider that the average amount of blood women lose during their entire period is 80 cc, or about the amount contained in a small Dixie cup. That’s right….your entire period flow should amount to less than a Dixie cup! It is not normal to change pads every 1-2 hours, or bleed through pads, or to double up with two pads or a pad and a tampon. Often, women’s periods become slowly heavier over many years, and they lose sight of what a “normal” period is.
Many women simply accept heavy or persistent bleeding as normal, and unfortunately, many doctors promote this idea by disregarding patient complaints. If you’ve ever said, “I can’t go tonight…I have my period,” then you probably have an abnormal period. Bleeding which restricts your activity, causes embarrassing accidents, or arrives unscheduled is not normal, and in most cases is easily and effectively treated.
Bleeding is “Heavy” With Your Period If
- Your pads or tampons soak quickly
- You ever use two or more pads at a time
- You miss work or school as a result of your period
- You rearrange your activities because of heavy bleeding
- You often soil clothes, sheets, or furniture during your period
Causes of Abnormal Bleeding
There are many causes of abnormal bleeding, but they can generally be grouped into hormonal and non-hormonal causes. Hormonal causes are quite common; the menstrual cycle is a finely choreographed physiological phenomenon, and can be disrupted by changes in diet, stress, weight, and other factors. Sometimes, abnormal bleeding can be related to normal physiologic changes in your hormones: You may not get your period for many months while breastfeeding, for example, or may find your periods coming closer together as you approach menopause. In other cases, hormonal imbalances like polycystic ovary syndrome or thyroid conditions can contribute to abnormal bleeding.
Abnormal bleeding always demands attention because gynecologic cancers often present with symptoms of bleeding.
Non-hormonal causes of bleeding include infections of the cervix, uterus, or other pelvic organs. Sexually transmitted infections like chlamydia or pelvic inflammatory disease frequently cause bleeding between periods. Sometimes, blood seen when wiping is found to originate from a urinary tract infection, and is actually not coming from the vagina at all.
Commonly, abnormal bleeding is found in association with abnormalities of the uterus like fibroids or polyps. Fibroids are benign tumors of the uterus, and are the most common anatomic causes of abnormal bleeding. Fibroids are very common, and don’t necessarily need to be removed if they are present. Sometimes, though, removal will be recommended due to bleeding, pain, or fertility issues, or due to rapid growth of the tumors. In most cases, removal consists of minimally invasive procedures which do not require a hospital stay, and permit you to return to work with minimal interruption: At The Woman’s Health Pavilion we excel at minimally invasive solutions like laparoscopic myomectomy and hysteroscopic myomectomy. Polyps are fleshy overgrowths of the inner lining of the uterus, and are usually (but not always) benign; polyps are easily removed with a no-incision day-surgery procedure. Both fibroids and polyps can cause heavy periods and bleeding in between periods. Certainly a woman who suspects she has fibroids or polyps needs to be evaluated and closely followed by a physician.
Abnormal bleeding always demands attention because gynecologic cancers often present with symptoms of bleeding. The most common presenting symptom of cervical cancer, for example, is bleeding between periods, especially with intercourse. Women with cancers in the inner lining of the uterus (endometrial cancer) typically present with bleeding after menopause. Women with abnormal bleeding should always seek care from a competent ob/gyn to rule out serious causes.
How is Abnormal Bleeding Evaluated?
Evaluation of abnormal bleeding typically begins with a simple examination of the vagina and cervix. If infection is suspected, cultures may be taken. Usually, trans-vaginal sonography is performed to evaluate the uterus and ovaries. Polyps, fibroids, and ovarian cysts can generally be detected with sonography. A special test called a hysterosonogram is especially useful to detect endometrial polyps and fibroids growing on the inside of the uterus: In this test, a thin catheter is inserted into the cervix, and used to introduce a small amount of sterile water inside the uterus. The water injected into the uterus distends, or opens up, the inner cavity, making polyps and fibroids inside the uterus quite obvious. If the cause of bleeding is not obvious, an endometrial biopsy may be performed to rule out serious disease in the uterus. During an endometrial biopsy, a thin plastic tube is inserted into the uterus, and used to obtain a sample of the inner lining. The test is a bit uncomfortable, but takes just a minute to perform, and is often essential to exclude the possibility of cancer in the uterus.
Treatment of Abnormal Bleeding
Treatment of abnormal bleeding depends on the cause. In many cases of hormonal bleeding, the solution is hormonal: Women’s cycles can be restored using birth control pills, or other medications which will provoke a normal monthly flow. In contrast, when bleeding is caused by fibroids or polyps, resolution of bleeding often requires treatment of the underlying condition. Fortunately, we are able to remove most fibroids using minimally invasive techniques like hysteroscopic myomectomy, laparoscopic myomectomy, or even laparoscopic hysterectomy if necessary.
It is estimated that 7 million women in this country suffer from excessive menstrual bleeding.
Patients frequently complain of excessively heavy periods. It is estimated that 7 million women in this country suffer from excessive menstrual bleeding. These women find themselves changing their pads or tampons frequently, flooding, clotting, and sometimes soaking through their clothes. Many report going to work with a bag full of feminine protection products, and still having embarrassing accidents. Often women have endured years of heavy periods—finding it difficult to leave the house one or two days each month—before they seek treatment.
For women with excessively heavy menstruation, endometrial ablation procedures are an extremely attractive option. Endometrial ablation is a simple day-procedure which takes just a few minutes to perform. In this procedure, a special instrument is used to burn the inner lining of the uterus, permanently inactivating it. The result is permanently light periods—typically just a few days with a panty liner.
At The Woman’s Health Pavilion, we provide solutions for women with abnormal bleeding. Whether you are bothered by your symptoms, or simply wish to know if your bleeding pattern is normal, we invite you to call for a consultation.
May We Help You?
Would you like to find out more about our treatments and services? Are you looking for a second opinion on a diagnosis or treatment recommendation you received at another practice? The experienced team at The Woman’s Health Pavilion is happy to help. Just let us know how and when you’d like to hear from us.