What is abnormal bleeding?
The normal interval between menstrual periods is 21-35 days. Most women have a duration of flow of no more than 7 days, and lose no more than 80 cc (or 2.8 ounces) of blood with each cycle. Women with an interval less than 21 days or greater than 35 days, with menstrual flow greater than 7 days duration, or with more than 80 cc of blood loss have abnormal bleeding.
What causes abnormal bleeding?
Most commonly, abnormal bleeding is caused by benign abnormalities of the uterus or cervix. Benign conditions include fibroids, polyps, adenomyosis, and infection. Occasionally, malignant and premalignant conditions are the cause of abnormal bleeding. Such conditions include endometrial hyperplasia, endometrial carcinoma, and cervical carcinoma. Systemic conditions such as bleeding disorders, thyroid or liver disease, and pregnancy and some medications such as oral contraceptives can also cause irregular bleeding.
When no organic cause of abnormal bleeding is identified, the patient is diagnosed with dysfunctional uterine bleeding (DUB).
How is abnormal bleeding diagnosed?
The patient’s age as well as the pattern of bleeding is extremely important in identifying the cause. Careful history is obtained to evaluate the frequency and the amount of bleeding. Blood tests such as blood count, clotting factors, and iron level can also be helpful in diagnosis and can identify the patients who need to be treated with iron supplementation.
Physical exam is performed to identify cervical or uterine masses or lesions. Some patients will require cervical or endometrial biopsy to aid in diagnosis.
Transvaginal ultrasound is a simple, noninvasive test that will yield a large amount of information regarding the uterus, tubes, and ovaries, and can measure the thickness of the endometrial lining. In postmenopausal patients, the endometrial lining should be less than 5 mm. The thickness of the lining can vary considerably for reproductive age patients.
Hysteroscopy is a useful technique in evaluating the uterine cavity and can identify polyps, fibroids, hyperplastic and malignant lesions. A small camera is inserted into the uterine cavity through the cervical canal and if polyps or fibroids are identified they can be removed by hysteroscopic resection. Often, hysteroscopy is followed by dilatation and curettage if there is no evidence of an obvious abnormality within the uterine cavity.
The tissue obtained from curettage is then sent for pathologic evaluation.
What are the treatment options for abnormal bleeding?
Please refer to Treatment Options for Abnormal Bleeding.