Abnormal vaginal bleeding

This is the most common reason for abnormal bleeding and occurs commonly after puberty and before the menopause.

As a result of non-ovulation, or improper function of the developing follicle or Corpus Luteum, one or both hormones which control the menstrual cycle i.e. Oestrogen and Progesterone, may not be secreted. This leads to a lack of support to the endometrium and irregular shedding and bleeding. It can also occur in reproductive years but is usually only temporary. Occasionally this occurs due to a functional ovarian cyst.

Ultrasounds can help to identify which hormone is missing in order to rule out the possibility of a cyst and, so a course of treatment can be prescribed to correct the abnormality that cycle.

Polyps are benign growths which occur in any body cavity due to an overgrowth of the cells of the lining. When they occur in the endometrium, they can lead to irregular bleeding. They can usually be seen by vaginal ultrasound, but sometimes it is necessary to inject sterile saline into the uterus to identify them accurately. They rarely become malignant and are commonly seen in women over the age of 30. The only way to treat them is by surgery.

Fibroids or Myomas are benign lumps in the muscular walls of the uterus. They occur most commonly in women over the age of 30, and more notably in those without children.

They can develop in the wall (intramural), project outside the uterus (subserous) or into the cavity (submucous). The subserous type rarely causes any symptoms unless it is more than 5 cm. The intramural type can cause heavy periods and the submucous may cause irregular bleeding, heavy periods and infertility.

All three types are easily diagnosed by a vaginal ultrasound. Fibroids need not be treated unless they are causing symptoms and treatment is usually by surgery.

Adenomyosis occurs as a result of some of the cells lining the inside of the uterus migrating into the wall of the uterus. Since these cells respond in the same way to the hormones secreted from the ovaries i.e. Oestrogen and Progestrone, it will grow, and bleed a small amount inside the muscles each month. This results in enlargement of the uterus and heavy periods. It may be diagnosed by ultrasound but MRI is more accurate. Medical treatment usually controls the bleeding.

Cancer of the lining of the uterus is an important cause of abnormal bleeding particularly after the age of 44 years and especially after the menopause. It can usually be diagnosed by vaginal ultrasound but sometimes an outpatient endometrial biopsy is necessary to confirm the diagnosis. Treatment is usually by surgery or irradiation.

Cancer of the cervix is more commonly seen in women over the age of 30 and rarely before. It can cause irregular bleeding but usually leads to Postcoital bleeding. It is normally diagnosed by a simple examination and sometimes by a smear test. Occasionally the use of an ultrasound is needed.

Pregnancy related bleeding can be a reason for abnormal bleeding, even if you have not missed a period. Many women believe that if they have not missed a period then it is not possible to be pregnant; this is not true. It is possible to have had bleeding as results of complications during the pregnancy. That is why it is important to have a pregnancy test whenever you have any abnormal bleeding. Sometimes it is necessary to measure the pregnancy hormone BHCG to exclude ectopic pregnancy or abnormal growth of the placenta e.g. Hydatidiform mole.

Bleeding after an intimate relation is described as provoked bleeding and is due to contact with the cervix. This may be due a benign polyp on the cervix, a vascular and inflamed cervix and more importantly may be due to a pre-cancerous abnormality on the cervix. It is therefore imperative that you see a doctor to examine the cervix both by the naked eye and by colposcopy.