Diagnosing and Evaluating Abnormal Uterine Bleeding
By Gretchen Makai, M.D.
Abnormal uterine bleeding is a common reason women see their doctors. Abnormal bleeding can occur at any age of life and has many causes – some are easily treated, while others are more serious. Women should consult with their health care providers if ever they have bleeding concerns.
The first step in diagnosing abnormal bleeding is to recognize normal and abnormal menstrual patterns for women in their reproductive years. Normal menstrual cycles usually start every 21 to 35 days; that is, a woman gets one period every three to five weeks. Bleeding that is more or less frequent than this is abnormal. In addition, bleeding between a woman’s regular cycles is not normal. Other important considerations include how much and how long a woman bleeds. Periods which cause women to bleed excessive amounts (technically, more than 80cc of blood per cycle) or that last more than seven days, are too heavy. Spotting-only or missing a cycle altogether is too little.
There are times in women’s lives when they may be more likely to have abnormal uterine bleeding. In the years immediately after a woman starts menstruating and again in the years before she enters menopause (defined as 12 months without a period), women may have irregular cycles due to the changes in hormonal regulation in the body. In addition, as women age, their chance of having a medical condition, structural lesion or other cause of irregular bleeding may increase. Regardless of age, any woman whose regular cycle suddenly changes is best advised to ask a doctor about it. Women who have any amount of bleeding after menopause should always seek an evaluation.
There are many causes of abnormal uterine bleeding, most of them benign. Pregnancy, changes in the hormonal cycle and structural abnormalities are common causes. Abnormal lesions in and around the uterus (for example, endometrial polyps or uterine fibroids) can interfere with the body’s natural way of slowing or stopping a woman’s period, resulting in excessive bleeding. They can also cause women to bleed between periods and produce other disruptive symptoms.
Numerous medical problems which affect the body’s hormones or overall health also cause changes in menstrual bleeding. Specific conditions which result in abnormal clotting may predispose women to heavy periods and medications that thin the blood may have similar effects. Certain infections in the uterus and cervix can trigger bleeding. Rarely, abnormal bleeding may be a sign of cancer.
Because there are so many causes for abnormal uterine bleeding, the evaluation of this problem starts with a thorough history by your care provider, including questions which address the issues above. He or she will ask specifically what changes are occurring, how long the changes have taken place, and what other symptoms or signs a woman may have experienced. Other information which a doctor may ask a woman include her medical and surgical history, family history, pregnancy history, sexual history and her use of medications, including tobacco and alcohol.
Overall, abnormal uterine bleeding in women of reproductive age is usually benign, but it often can, and should be, treated. For these reasons, women are encouraged to seek care if they are having bleeding concerns. Any woman who has bleeding in menopause should see her doctor for an evaluation.
Gretchen Makai, M.D., is Christiana Care’s Director of Minimally Invasive Gynecologic Surgery and a physician at the new Christiana Care Center for Women’s Health.
The Christiana Care Center for Women’s Health offers a group of women’s health specialists focused on gynecologic issues that may become more complex for women within and beyond their child bearing years – conditions that can often only be addressed by special consultation, advanced treatment or surgery. The Center for Women’s Health is located at 3706 Kennett Pike in Greenville. For more information or to schedule an appointment, call 302-623-6320.