Abnormal Vaginal Bleeding
Many women experience bleeding or spotting between periods. Vaginal bleeding is considered to be abnormal if it occurs:
At a time in life when it is not expected, such as:
- When you are not expecting your menstrual period.
- When your menstrual flow is lighter or heavier than what is normal for you.
Abnormal vaginal bleeding has many possible causes. By itself, it does not necessarily indicate a serious condition.
- Before age 10.
- During pregnancy.
- After menopause.
Emotional Stress, Hormonal Imbalance
Extreme emotional stress and excessive exercise can cause abnormal bleeding, although excessive exercise more frequently causes an absence of menstruation (amenorrhea).
Hormonal imbalances caused by other diseases, such as hyperthyroidism or diabetes, also can cause abnormal bleeding. Uterine fibroids are a common cause of heavy periods. For more information, see the topic Uterine Fibroids.
In all of these situations, if the bleeding is not heavy and occurs only occasionally, there is probably no cause for concern.
Other, less common causes of abnormal vaginal bleeding that may be more serious include the following:
- Infection of the pelvic organs (vagina, cervix, uterus, fallopian tubes, or ovaries) may cause vaginal bleeding, especially after intercourse or douching. Sexually transmitted diseases (STDs) are often the cause of infections.
- In a young girl who has not started to menstruate, vaginal bleeding can indicate sexual abuse or that an object is in the vagina. The cause of bleeding needs to be determined by a health professional to rule out these possibilities. Other causes of vaginal bleeding include urethral prolapse, ovarian tumors, or polyps cervical polyps or cancer of the cervix may cause bleeding after intercourse.
- Heavy bleeding during the first few weeks after delivery (postpartum) or after an abortion may indicate that the Fetal tissue remains in the uterus (retained products of conception). The uterus has not contracted to the pre-pregnancy size.
What Increases Your Risk
Factors that increase your risk of developing dysfunctional uterine bleeding related to hormone levels and lack of ovulation include:
- Anovulatory dysfunctional uterine bleeding is more common in teens, at beginning of the reproductive years, and in perimenopausal women at the end of their reproductive years.
- Overweight women more commonly develop dysfunctional uterine bleeding.
Because bleeding can indicate a problem with pregnancy, possible pregnancy should always be considered in a woman of childbearing age.
Spotting to minimal bleeding may be normal, but any bleeding during pregnancy needs to be evaluated by your health professional.
Heavy vaginal bleeding or bleeding that occurs before 12 weeks may indicate a serious problem, including an ectopic pregnancy or miscarriage.
Heavy vaginal bleeding or bleeding that occurs after 12 weeks may indicate a serious problem, such as placenta previa. Ovulation can cause midcycle bleeding.
If you are age 40 or older, abnormal vaginal bleeding may mean that you are entering perimenopause. In a woman who has not had a menstrual period for 12 months, vaginal bleeding is always abnormal and should be discussed with a health professional.
Medications, IUD, Breast Feeding
Medications, such as birth control pills, sometimes cause abnormal vaginal bleeding. You may have minor bleeding between periods during the first few months if you have recently started using birth control pills. You also may have bleeding if you do not take your pills at a regular time each day.
An intrauterine device (IUD) also may increase your chances of spotting or heavy periods.
Women who are breast-feeding may have irregular vaginal bleeding or spotting.
Examinations and Tests
Diagnosis of dysfunctional uterine bleeding is a "diagnosis of exclusion." This means that your health professional must first rule out all other medical causes of vaginal bleeding before a diagnosis of dysfunctional uterine bleeding is made.
First, your health professional will:
Review your history of symptoms and menstrual periods. (If possible, bring a calendar of your symptoms with you.) Determine whether you are ovulating regularly. This is evaluated using one or more of the following:
If your symptoms are severe, your health professional suspects a serious medical problem, or you are considering a certain treatment, you may also have one or more other tests, such as:
- Your menstrual calendar
- A daily basal body temperature chart, if you have been keeping track at home.
- A progesterone test (low levels during the third week of a menstrual cycle suggest an ovulation problem).
- An endometrial biopsy during the fourth week of your menstrual cycle. Perimenopausal women typically have an endometrial biopsy because abnormal endometrial tissue is common in this age group.
- Conduct a routine pelvic examination.
- Use a transvaginal pelvic ultrasound, to check for any abnormalities in the pelvic area. After the pelvic examination, a transvaginal ultrasound is often the next step in diagnosing a vaginal bleeding problem. If a pelvic mass is found, ultrasound results are useful for making further testing and treatment decisions.
Blood tests, which may include:
- Pregnancy test (human chorionic gonadotropin, or hCG).
- Complete blood count (CBC), to check for signs of disease, infection, and anemia.
- Thyroid-stimulating hormone (TSH) to check for a thyroid gland problem, which can cause menstrual irregularity.
- Serum prolactin level, to check for a pituitary gland problem, which can interfere with or stop the menstrual cycle.
- Serum ferritin, to check for anemia, a symptom of heavy blood loss.
- Pap smear and cultures to check for infection or abnormal cervical cells.
- Urine test to screen for infection, disease, and other signs of poor health.
- Endometrial biopsy, usually for the perimenopausal or post-menopausal woman, to learn whether the endometrium is healthy and functioning normally.
- Hysteroscopy, if no cause is apparent but a problem condition is suspected; to check for and treat a suspected condition, such as uterine fibroids; or if bleeding continues despite treatment. Hysteroscopy is preferred over the technique of dilation and curettage (D&C), which can miss areas of bleeding in the uterus.
Endometrial cancer risk increases with age. Also known as uterine cancer, it is most common in women over age 50, after menopause. However, endometrial cancer can also develop earlier, during perimenopause.
If you have heavy or unusual vaginal bleeding after your menopause, your health professional will use an endometrial biopsy to check for cancerous cell growth.
If you are perimenopausal and have not responded to other treatment for uterine bleeding or have risk factors for endometrial cancer, your health professional may order an endometrial biopsy.
Medications To Treat Dysfunctional Uterine Bleeding
Treating dysfunctional uterine bleeding with medications has fewer risks but is not always as effective as surgical treatment. If you plan to become pregnant in the future, or if you are nearing the time when your menstrual periods will stop (menopause), medications may be right for you.
Goals of Medical Treatment
The goal of medication treatment for dysfunctional uterine bleeding is to reduce or eliminate blood loss. This can be accomplished in one or both of the following ways:
- Reducing the endometrium's rate of blood loss, as with an NSAID.
- Regulating the menstrual cycle by changing hormonal levels.
There are several medication and hormone therapies for managing dysfunctional uterine bleeding.
What To Think About-Hormone Therapy
- Non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment choice for dysfunctional uterine bleeding. They reduce heavy blood loss and cramping by lowering prostaglandin levels, which are linked to uterine bleeding.
- The levonorgestrel intrauterine device (IUD) is a birth control method that increases progesterone levels, which regulates the menstrual cycle and reduces bleeding and cramping. For more information, see intrauterine device (IUD) for birth control.
- Progestins (synthetic progesterone) promote ovulation in women who aren't ovulating, which regulates the menstrual cycle and reduces bleeding and cramping. In some women who are ovulating, progestins can control endometrial growth and bleeding.
- Birth control pills (synthetic estrogen and progesterone) regulate the menstrual cycle, which reduces bleeding and cramping and prevents pregnancy. Estrogen quickly reduces dangerously heavy bleeding by triggering rapid growth of the endometrium.
- Rarely used hormone suppressors such as danazol and gonadotropin-releasing hormone analogues (GnRH-As) stop the menstrual cycle and bleeding by reducing estrogen production; problematic side effects are common.
Intravenous estrogen therapy is generally used on an urgent basis, when severe blood loss must be quickly stopped. After bleeding subsides, a week or so of progestin or estrogen–progestin therapy is added to help return the menstrual cycle to normal.
Hormone suppressors, such as GnRH-As, are sometimes used as a last alternative to surgical treatment. They have serious side effects and can only be used for short periods of time.
Treatment with danazol (a synthetic testosterone, or male hormone) can be a last alternative before surgical treatment, although it is unacceptable to many women. While it effectively reduces menstrual blood loss, it causes significant side effects and must be taken in large doses.
Surgery is generally reserved for treating dysfunctional uterine bleeding that can't be controlled with medication.
The following procedures are used to treat dysfunctional uterine bleeding.
What To Think About
- Hysteroscopy can be used to diagnose and treat dysfunctional uterine bleeding at the same time. When areas of bleeding are located, biopsies can be taken and then the areas of bleeding can be treated with either a laser beam or electric current (electrocautery).
- Endometrial ablation is a minimally invasive alternative to hysterectomy when other medical treatments fail or when you or your doctor have reasons for not using other treatments. Endometrial ablation scars the uterine lining, so it is not a treatment option if you are planning to become pregnant.
- Hysterectomy, the removal of the uterus, is done when a sample of the uterine lining (endometrial biopsy) shows abnormal cell changes or cancer, when uterine bleeding is uncontrollable, or when the cause of chronic bleeding cannot be found and treated. Some women prefer hysterectomy to medications with troublesome side effects. However, a hysterectomy is a major surgery with risks of complications, which requires a prolonged recovery and long-term estrogen replacement therapy after surgery.
- Dilation and curettage (D&C) is sometimes used to control sudden, heavy vaginal bleeding. It is the quickest way to stop bleeding in the uterus.
Hysteroscopy is typically done to rule out serious uterine conditions.
Before long-term treatment with medications or surgical treatment for dysfunctional uterine bleeding. When uterine bleeding has continued despite conservative treatment.
Natural Alternatives to Dysfunctional Uterine Bleeding
Bioidentical progesterone cream (Progensa 20)
Bioidentical progesterone cream increases progesterone levels. You need adequate and sustain levels of progesterone to induce ovulation. Dysfunctional uterine bleeding is due to too little progesterone being produced by the body.
Herbal Formula (ProSoothe)
ProSoothe is an all natural herbal formula that significantly improves uterine fibroids and pelvic pain/cramps, irritability, tension, mood swings, acne, headaches, breast pain, bloating and weight gain.
Also found in this synergistic herbal formula is dandelion and vitex,(chaste tree) that helps the body remove exogenous,(external excess estrogen)from hormone therapy or contaminated food,(xenosteroids).
Milk Thistle (Silymarin)
Beyond the treatment of liver disorders, everyday care of the liver lays a cornerstone for total body health. Naturopaths and others who look beneath the symptoms of an illness to its underlying cause, often discover that the liver has had a role to play. This is true across a vast range of different ailments from headaches to PMS.
More Information-Dysfunctional Bleeding
Dysfunctional Uterine Bleeding
Dysfunctional Uterine Bleeding-Condition Treatments