Abnormal Uterine Bleeding

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A normal menstrual period lasts from 2 to 7 days. The normal cycle patterns can range from 21 to 35 days. When bleeding occurs that is not part of the regular cycle; periods are longer or heavier than normal; occurs between periods; time between periods is longer than normal; or there is an absence of periods, this is called abnormal or irregular uterine bleeding. There are various causes of abnormal bleeding, but the most common is a hormone imbalance. At both ends of the menstrual life of a woman, periods may be irregular. Reasons for abnormal periods can be both normal and abnormal. The most normal reason is pregnancy. Hormone imbalance (not enough or too much of certain hormones) can also be a common reason. This can occur as a result of weight loss or gain; heavy exercise; stress; illness; or certain medications. The most common result of a hormone imbalance is loss of ovulation. If this occurs over a long period of time, a condition called endometrial hyperplasia can occur. Endometrial hyperplasia is the result of constant estrogen bombardment of the endometrium (the lining of the uterus shed every month with your period). Untreated, endometrial hyperplasia (when the lining of the uterus becomes too thick) can sometimes turn into cancer.

There are many reasons for abnormal/irregular periods. The chart below will list the most common reasons, their cause, other symptoms that may occur, diagnostic methods and treatment options. Remember, this is not a replacement for the advice of your care giver, but rather information to help you become aware of your body.

Irregular/Abnormal Bleeding

CONDITION	CAUSE	OTHER SYMPTOMS	DIAGNOSIS	TREATMENT OPTIONS
POLYCYSTIC OVARY DISEASE (SYNDROME)	No ovulation	Irregular bleeding, irregular periods, infertility, acne , excessive hair growth	Made with examination and lab tests to check hormone levels	Birth control pills, progesterone supplementation every three months; infertility drugs when pregnancy desired
PREGNANCY	Can be normal; as a result of miscarriage or ectopic (tubal) pregnancy	May have right or left lower abdominal pain; cramping	Pregnancy test, sonogram	If normal – observe; miscarriage may need a D&C; ectopic is a medical emergency and needs IMMEDIATE Surgery
INFECTIONS OF THE UTERUS OR CERVIX	Some Sexually transmitted diseases	Pain with period, foul smelling discharge, greenish to green-yellow discharge	Exam, cultures, other specific blood test	Appropriate for the STD
IUD	Irritation of the lining of the uterus. The uterus can’t stop bleeding after a period	Cramping, heavy clotting	If periods were normal before the IUD was placed, you may need to have it removed. If they return to normal after removal, the IUD was the cause	Remove the IUD
BIRTH CONTROL PILLS	Missed pills, newly starting the pill, improper hormone mixture for YOUR body	Brown staining to bright red bleeding in the middle of the cycle; heavy to no periods	Missed pills are obvious; your doctor can make the diagnosis based on the description of what your periods are like compared to before starting the pill	Wait for 2-3 months after starting a new pill; change pills
UTERINE FIBROIDS	Growths of smooth muscle non- cancerous tumors in the uterine muscle. These are more common in black women, but are not uncommon in white women. They are very uncommon in Oriental women	Heavy periods, bleeding between cycles, problems with kidneys, increasing abdominal girth, pressure feelings in the lower abdomen, infertility	Exam, sonogram, possibly MRI	Dependant on the size and symptoms a myomectomy, rather than a hysterectomy, can be done. This removes the fibroids and rebuilds the uterus
BLOOD CLOTTING PROBLEMS	Von Willebrand’s Disease, Factor abnormalities, hemophilia	Heavy periods; long periods lasting more than 10 days; clotting	Exam, family history, appropriate blood test	Treatment based on the disease
CANCER OF THE UTERUS, CERVIX, OR VAGINA	Cancer can cause abnormal bleeding cause normal tissues are not present	Heavy bleeding, bleeding with intercourse, bleeding between periods	Exam, biopsy, D&C, other testing specific for the cancer looked for	Surgery specific to the cancer found
GENETIC ABNORMALITY IN REPRODUCTIVE ORGAN ANATOMY	Abnormal development of the organs	No periods, heavy periods	Exam, sonogram, hysterosalpingogram (putting dye in the uterus to look at the anatomy of the uterus and tubes)	Surgery if needed to nothing at all

©1997: MJ Bovo

If any of the above symptoms trouble you or appear to be what you are experiencing, please consult your doctor as soon as possible.

ADDITIONAL RESOURCES THAT MAY HELP:

	Be Part of a Nationwide Research Study on Abnormal Uterine Bleeding
	Good Links and explanations from About.com (The Mining Company)
	Excellent Explanations from the Australian Medical Journal
	Diagnosing Abnormal Uterine Bleeding: What it Really is
	Abnormal Uterine Bleeding More Explanations

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