Abnormal Bleeding

Abnormal Bleeding Definition

What is abnormal or irregular bleeding in females?  Abnormal bleeding includes bleeding that occurs in between your menses (period). Menstrual bleeding that is prolonged or heavy enough to result in anemia or to interfere with your normal activities is also abnormal.

Abnormal bleeding in women also includes bleeding in young girls before they begin their menstrual periods and is frequently due to hormonal problems. Bleeding after the menopause or change is not normal.

Abnormal bleeding in women may come from sites (places) other than the uterus including the vagina, bladder, vulva (external female parts), or rectum.

After menarche (the first menstrual cycle or period), most women have a menstrual cycle every 21-35 days that lasts 3-7 days. If you bleed less than 21 days apart or more than 35 days from the first day of bleeding to the first day of the next, discuss this with your physician.

As a woman approaches the menopause, it is normal to occasionally skip a menstrual period and finally have her last menses – hence the term meno- pause. Once a woman has not had a period for one year she is considered to be postmenopausal. Unless cyclic menses are being induced by hormonal replacement therapy (estrogen and progesterone), any bleeding after the menopause is abnormal bleeding, even if it is just a single brown spot.


Causes for Abnormal Bleeding

What are some of the causes for abnormal uterine bleeding? Abnormal uterine bleeding may be associated with any of the following conditions.

  • Problems with a pregnancy such as threatened miscarriage, a tubal pregnancy, or placenta previa when the after-birth blocks the cervical canal
  • Infection involving the lining of the uterus
  • An IUD (intrauterine device for birth control)

  • primary bleeding disorder when a patient does not clot her blood properly (bleeds excessively when she gets a cut, etc.)
  • Scar tissue or blockage within the uterus (womb)
  • Benign (not cancer) growths such as fibroids, polyps, or simple overgrowth of the lining of the uterus
  • Pre-cancer or cancerous conditions (tumors) of the lining of the uterus
  • Hormonal treatment or even lack of hormones.


Worry About Abnormal Bleeding
Why should I be concerned about abnormal bleeding? If a woman ever gets a pre-cancerous condition of the uterus or even true uterine cancer, it can be cured in most instances if it is found early enough. The key is early diagnosis. As with any cancer, it can lead to the death of the patient if it is allowed enough time to grow and spread. Fortunately, when compared to many cancers in other parts of the body, uterine cancer, with rare exception, is slow growing and can usually be caught before it has time to spread.  Fortunately, most women with abnormal bleeding do not have cancer.

Amount of Bleeding

What if I only had a small amount of bleeding, or even just a brown discharge? The amount or character of the bleeding is less important than the timing. A few years ago a 63 year old lady presented only having a small amount of brownish discharge for a few hours, after not having a menstrual period for over 10 years.
Evaluation revealed an early uterine cancer, the patient was treated and she is doing well with no evidence of recurrent disease. Again, it is important to emphasize that the time when the bleeding occurs is much more important than the amount or color of the bleeding.

The PAP Smear and Finding the Source of Bleeding

How is the source of the bleeding determined? What about the PAP smear? The PAP smear does an excellent job of screening for pre-cancer and cancer of the cervix (mouth of the womb) but is not reliable for diagnosing causes of abnormal bleeding that come from inside the uterus. The patient’s medical history and physical examination are frequently all that are necessary to determine the cause of the bleeding. 
Also, specific lab tests or x-rays may be helpful in arriving at the correct diagnosis.  Certain causes of abnormal bleeding however may require a closer look at the endometrium (lining of the uterus or womb).

Diagnosing the Cause of Bleeding

How do we get this closer look at the endometrium? In years past, the so-called D&C (scraping the lining) was performed in an attempt to diagnose the condition. Two problems exist with the D&C – it requires general anesthesia, and it is a “blind” procedure (it is done by feel, not by seeing, and has a good chance of missing an abnormality of the lining). More recently, hysteroscopy has been performed to more accurately diagnose abnormal uterine bleeding. Hysteroscopy utilizes a skinny telescope-like instrument to look inside of the uterus through the cervix (mouth of the womb), requires no incisions and is highly accurate; but in most instances general anesthesia is used which means going to the operating room.
The newest innovation to diagnose the cause of abnormal uterine bleeding is called fluid-contrast ultrasound or sonohysteroscopy.  Along with an endometrial biopsy (both done in the office), these procedures allow accurate diagnosis without having to undergo the trouble and expense of general anesthesia that is required with D&C and hysteroscopy. It should be pointed out that hysteroscopy may be necessary if an abnormality is seen at the time of fluid-contrast ultrasound, if the procedure does not diagnose the cause, or if abnormal tissue is found on endometrial biopsy.

Treatment of Abnormal Bleeding

How is abnormal uterine bleeding treated? The treatment depends on the specific cause of the bleeding and whether or not there are other conditions that need to be treated at the same time. If the only condition that needs to be treated is bleeding, hysterectomy is rarely indicated.

The information provided by Advanced Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes only. As each woman is unique, do not rely on this information for diagnosis and treatment. We cannot guarantee the accuracy of the content and advise that you see a qualified Health Care Professional for individual needs and care.

 Advanced Healthcare for Women
5354 Reynolds Street, Suite 518
Candler Professional Building
Savannah, Georgia 31405
Telephone 912-355-7717
Fax 912-355-0979