Vaginal Bleeding


Abnormal vaginal bleeding can happen for a variety of reasons. Learn when the bleeding is considered to be abnormal and what the potential causes of abnormal vaginal bleeding are.


Normal vaginal bleeding

Normal vaginal bleeding (menorrhea) or menstruation is a part of a woman’s menstrual cycle. It occurs every 21 to 35 days and may last for two to seven days. The ovaries are the main source of female hormones which regulate the menstrual cycle.

What is abnormal vaginal bleeding?

Abnormal vaginal bleeding is a gynecological condition that happens due to a medical condition and is unrelated to normal menstruation. Vaginal bleeding that happens between periods is said to be abnormal and is termed as intermenstrual bleeding, spotting, and metrorrhagia. Abnormal vaginal bleeding happens either during the wrong time of the month or in inappropriate amounts. Some of the causes of this condition may be easy to treat. This requires medical attention and immediate treatment. 

When abnormal vaginal bleeding happens?

·         When you are not expecting your menstrual cycle to happen

·         After sex

·         After menopause

·         When the menstrual blood flow is lighter or heavier than what is supposed to be normal for you

·         In girls who are less than nine years old

Causes of abnormal vaginal bleeding

Most causes of abnormal bleeding are due to irregular ovulation. The causes of abnormal vaginal bleeding includes

  • A growth in your uterus or cervix
  • Stress
  • Infections like endometritis, pelvic inflammatory disease
  • During pregnancy: It is reported that 20 to 30% of women may experience vaginal bleeding during their pregnancy.  Vaginal bleeding is more common in women who carry twins and other multiple gestations than in women who carry a single fetus. The scant amount of blood that is noticed during the first two weeks of pregnancy could be due to “implantation bleeding”. The causes of vaginal bleeding can also be due to ectopic pregnancy, miscarriage, cervical infection and premature labour.
  • A hormone imbalance: The imbalance between the levels of estrogen and progesterone hormones can cause abnormal bleeding. Thyroid problems, PCOS, dysfunctional ovaries can cause hormonal imbalance. Abnormal vaginal bleeding can also happen when starting any hormonal contraceptives.
  • Vaginal bleeding that happens after sexual intercourse could be due to injuries to the vaginal wall during intercourse, any infections and anatomical lesions.
  • Cancer and precancerous conditions like cervical, endometrial, vaginal and ovarian cancer
  • Usage of birth control pills and intrauterine devices
  • The less common causes include sexual abuse, uterine fibroids, structural problems and blood clotting disorders.

 

Diagnosis of abnormal vaginal bleeding

 

You should seek immediate medical attention if you notice abnormal vaginal bleeding. If you have pain, fatigue, fever and dizziness, contact your physician immediately. Have a record of your menstrual cycle history.  Tell your physician the duration and heaviness of your bleeding.

A physical examination and a pelvic examination are performed to identify the cause of abnormal vaginal bleeding.  Some of the following diagnostic tests are performed.

 

·         A blood clotting profile

·         Thyroid function and other hormone profile

·         A pregnancy test

·         Tests for sexually transmitted disease

·         Ultrasound

·         Pelvic MRI to visualize fibroids and cancers

·         Endometrial biopsy

·         A pap smear to rule out cervical cancer

 

Treatment for abnormal vaginal bleeding

Treatment for abnormal vaginal bleeding depends on the underlying cause.

·         Hormonal treatment in case of absence of ovulation

·         If the cause is due to precancerous changes, progesterone medications is prescribed

·         If the cause of bleeding is infection, antibiotics are prescribed

·         Uterine fibroid embolization (UFE): For treating fibroids, special procedures are performed. UFE is an invasive procedure, where fibroids are shrunk and the blood flow is arrested.

·         Endometrial ablation: In this procedure, the lining of the uterus is destroyed using a laser.

·         The surgical removal of fibroids is carried out by a procedure called myomectomy.

·         Dilation and curettage (D&C): If the excessive bleeding is not controlled by medicines, D and C is done. Here, the endometrial tissue is gently scraped or suctioned from the uterus.

·         Hysterectomy: When hormone medications become insufficient to control excessive vaginal bleeding and the cause is either cancerous or precancerous condition, a hysterectomy is performed that involves the removal of the uterus.

 

Prevention of abnormal vaginal bleeding

·         Maintain a healthy weight

·         Use birth control pills and hormone therapy as directed by the physician

·         Manage your stress with relaxation techniques

·     Always use any medicine after doctor’s consultation and use the recommended doses

The underlying cause of vaginal bleeding has to be identified and medical attention should be sought.


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