Abnormal Bleeding

What is Abnormal Bleeding?

Abnormal bleeding refers to any unusual bleeding patterns that deviate from the normal menstrual cycle or occur in non-menstrual areas of the body.

Abnormal uterine bleeding (AUB) is a term commonly used to describe irregularities in menstrual bleeding, including frequency, duration, and bleeding volume variations. Abnormal bleeding can also refer to bleeding outside of the reproductive system, such as gastrointestinal, nasal, or urinary tract bleeding.

Impact of Abnormal Bleeding on Health

Immediate Health Impacts

• Anaemia: Chronic heavy bleeding can lead to iron-deficiency anaemia, causing fatigue, weakness, dizziness, and shortness of breath.
• Pain and Discomfort: Severe bleeding can be accompanied by abdominal pain, cramping, and discomfort.
• Interference with Daily Activities: Frequent or heavy bleeding can disrupt daily activities, work, and social engagements.
• Emotional and Psychological Effects: Chronic abnormal bleeding can lead to stress, anxiety, and depression.

Long-term Health Impacts

• Reproductive Health Issues: Persistent abnormal bleeding can be a sign of underlying reproductive health problems that may affect fertility.
• Risk of Infections: abnormal uterine/vaginal bleeding could indicate an underlying infection, such as endometritis, STIs, or pelvic inflammatory disease.
• Complications of Underlying Conditions: If abnormal bleeding is due to an underlying condition like fibroids or cancer, delaying diagnosis and treatment can lead to serious complications.

Causes and Risk Factors for Abnormal Bleeding

Age-related Factors

• Adolescents: Hormonal fluctuations during puberty can cause irregular menstrual cycles.
• Perimenopausal Women: Hormonal changes leading up to menopause can result in irregular and heavy bleeding.
• Postmenopausal Women: Any bleeding after menopause is considered abnormal and warrants medical evaluation. Although the majority will have a benign cause, in about 10% of women the postmenopausal bleeding might be due to uterine cancer.

Medical Conditions

• Polycystic Ovary Syndrome (PCOS): A hormonal disorder causing irregular menstrual cycles and abnormal bleeding.
• Thyroid Disorders: Both hyperthyroidism and hypothyroidism can disrupt menstrual cycles.
• Coagulation Disorders: Conditions like von Willebrand disease or haemophilia can cause abnormal bleeding.
• Endometriosis: Endometrial tissue outside the uterus can lead to abnormal bleeding patterns and associated pain.

Lifestyle and Environmental Factors

• Obesity: Excess body weight can lead to hormonal imbalances affecting menstrual cycles.
• Stress: High-stress levels can disrupt the hypothalamic-pituitary-ovarian axis, leading to irregular bleeding.
• Intensive Physical Activity or excessive weight loss: Athletes or individuals engaging in excessive physical exercise may experience changes in menstrual patterns due to hormonal imbalances.

Medications and Treatments

• Hormonal Contraceptives: Birth control pills, intrauterine devices (IUDs), and other hormonal treatments can cause irregular bleeding.
• Anticoagulants: Medications that thin the blood can increase the risk of abnormal bleeding.
• Cancer Treatments: Chemotherapy and radiation therapy can affect menstrual cycles and cause abnormal bleeding.

Other Risk Factors

• History of Gynecological Surgery: Surgeries like dilation and curettage (D&C) or endometrial ablation can alter menstrual patterns.
• Sexual Activity: Sexually transmitted infections (STIs) can lead to abnormal bleeding.
• Genetic Predisposition: A family history of bleeding disorders or gynaecological conditions can increase risk.
• Cervical ectropion: Occurs when the cells from inside the cervix become visible on the outside of the cervix. This condition is not concerning and is considered a harmless variation in the appearance of cervical cells.

Symptoms of Abnormal Bleeding

• Heavy or prolonged menstrual bleeding: Menstrual bleeding that lasts longer than seven days or involves the use of multiple pads or tampons per day.
• Irregular or frequent uterine bleeding: Bleeding occurs between periods or periods less than 21 days apart.
• Vaginal bleeding after sex (postcoital bleeding) occurs shortly after sexual intercourse.
• Vaginal bleeding during pregnancy: Any bleeding during pregnancy should be evaluated by a healthcare provider as it can indicate a potential risk to the pregnancy.
• Vaginal bleeding in children and adolescents: Any vaginal bleeding in girls who have not yet begun menstruation or are not yet of reproductive age should be evaluated by a healthcare provider.
• Spotting or light bleeding: less bleeding but more frequent than normal.
• Abdominal pain or cramping: abdominal pain or cramping that may accompany abnormal bleeding
• Fatigue or weakness: Feel tired or lightheadedness that may be a sign of blood loss

Reduce the Risk of Abnormal Bleeding

While not all cases of abnormal bleeding can be prevented, certain measures can reduce the risk:

• Maintain a Healthy Weight: Maintaining a healthy weight can help regulate hormonal balance.
• Manage Stress: Practising stress-reducing techniques such as yoga, meditation, and regular exercise can help maintain hormonal balance.
• Regular Exercise: Moderate physical activity can promote overall health and hormonal balance.
• Balanced Diet: Eating a well-balanced diet rich in iron, vitamins, and minerals can support overall health and prevent anaemia.
• Regular Medical Check-ups: Routine gynaecological exams can help detect and address issues early.
• Medication Management: Following prescribed medication regimens and discussing any side effects with a healthcare provider can help manage abnormal bleeding.
• Avoid Smoking and Alcohol: Limiting or avoiding smoking and alcohol can improve overall health and hormonal balance.

Types of Abnormal Bleeding

• Heavy Menstrual Bleeding (Menorrhagia): Excessive menstrual blood loss.
• Intermenstrual Bleeding (Metrorrhagia): Bleeding between menstrual periods.
• Postmenopausal Bleeding: Bleeding after menopause.
• Polymenorrhea: Frequent menstrual periods occurring less than 21 days apart.
• Oligomenorrhea: Infrequent menstrual periods occurring more than 35 days apart.
• Amenorrhea: Absence of menstrual periods for more than three months.
• Dysfunctional Uterine Bleeding (DUB): Abnormal bleeding with no identifiable cause.

Diagnosis of Abnormal Bleeding

Dr Alyousif may begin with a thorough medical history and physical examination to diagnose abnormal bleeding. This may be followed by additional tests and procedures, such as:

• Pelvic exam: A pelvic exam allows a healthcare provider to inspect the pelvic organs, including the uterus, ovaries, and cervix, for any signs of structural abnormalities or growth.
• Cervical screening test (Pap smear): This test checks for cervical cancer or other changes in the cervix that may cause abnormal bleeding.
• Blood tests: Blood tests may be used to check for hormonal imbalances, bleeding disorders, or other medical conditions causing abnormal bleeding.
• Ultrasound: Ultrasound can visualise the reproductive organs and check for structural abnormalities or growths, such as fibroids, polyps, or cysts.
• Biopsy: A biopsy is a procedure that involves removing a small sample of tissue from the uterus, cervix, or other reproductive organs to be analysed under a microscope. This can help determine the cause of abnormal bleeding.
• Endometrial sampling: A thin tube is inserted through the cervix into the uterus, and a small amount of tissue is taken. This procedure checks for abnormal growths or changes in the uterus lining.

Treatments for Abnormal Bleeding

The types of treatment for abnormal vaginal bleeding are based on many factors, such as 

• cause of bleeding, 
• age and 
• whether you want to have a child.

Most cases of abnormal vaginal bleeding can be treated with medications, except for a few instances that may require surgery. The goal of treatment is to either treat the underlying cause or manage symptoms and improve the your quality of life. Working closely with your gynaecologist to create a treatment plan tailored to your needs and circumstances is crucial.

Medications for Abnormal Bleeding

Several medications can be used to treat abnormal bleeding, depending on the underlying cause. Dr Alyousif may prescribe medications that include:

• Birth control pills, patches, or vaginal rings: These medications contain a combination of oestrogen and progestin, which can regulate menstrual bleeding and balance hormones in the body.
• Progestin therapy: Progestin-only therapy, such as the Progesterone implant or a progestin-releasing IUD, can help regulate menstrual bleeding.
• GnRH agonists: This medication temporarily lowers oestrogen and progesterone levels, which stops menstrual bleeding.
• Non-steroidal anti-inflammatory drugs (NSAIDs) can manage menstrual cramps and heavy bleeding.
• Tranexamic acid: This medication can help reduce heavy menstrual bleeding by slowing down the breakdown of blood clots.
• Antibiotics: For an infection, it will be treated with antibiotics.

Surgical Treatment for Abnormal Bleeding

Dr Alyousif will recommend surgical treatment depending on the cause of the bleeding. Some of the surgical options include: 

• Hysteroscopy is a procedure in which a thin, lighted tube is inserted into the uterus through the cervix to diagnose or treat abnormal bleeding.
• Endometrial ablation: This procedure destroys the uterus lining to reduce or stop heavy menstrual bleeding.
• Myomectomy: This surgery removes fibroids, which are benign uterine growths.
• Hysterectomy: In severe cases or if no other options have worked, a hysterectomy (removal of the uterus) may be recommended to treat abnormal bleeding.
• Laparoscopic surgery can treat endometriosis, where the tissue that lines the uterus grows outside of it.

Surgical treatment should be considered only after other options have failed or if a serious condition like cancer causes bleeding. In complex surgical cases, Dr Alyousif may involve another gynaecologist with sub-specialisation in the relevant treatment. In addition to these treatments, you can take good care of yourself by eating a well-balanced diet, exercising, and getting a proper amount of sleep.

What if Abnormal Bleeding is Untreated?

Abnormal bleeding, whether related to menstrual irregularities or other types of bleeding, should not be ignored. Seeking timely medical advice and treatment is crucial to preventing the complications outlined above. Proper diagnosis and management can significantly improve quality of life, reduce health risks, and improve overall health outcomes. If you experience abnormal bleeding, consult a gynaecologist to determine the underlying cause and appropriate treatment plan.