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What exactly is abnormal uterine bleeding? |
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What causes abnormal uterine bleeding? |
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What are the symptoms? |
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Could it be cancer? |
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What is the best way to diagnose abnormal uterine bleeding? |
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What are the treatment options? |
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What exactly is abnormal uterine bleeding?
Bleeding is considered abnormal
when the menstrual period is prolonged. The typical menstrual
period is 7 days or less. Any time a period is longer than
7 days it can be is considered abnormal. Bleeding between
periods may also be a sign of pathology. When the menstrual
period increases in flow, the patient may begin using super
and overnight pads or tampons. Passing large clots and flooding
is also a sign of a potential problem.
The average blood loss during
a menstrual period has been precisely studied. Typically
a woman changes a regular pad or tampon 3-6 times a day
during the heaviest parts of her menstrual period. A menstrual
blood loss calendar(MBLC) is used in research studies to
measure success in therapy for abnormal bleeding. The MBLC
requires daily comparison of used products to a chart of
pictures or cartoon illustrations, it is a little inconvenient.
In every day clinical practice an estimate of MBLC can be
made through discussion of pad and tampon use.
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What causes abnormal uterine bleeding?
Approximately one third of women
over 35 years of age with abnormal bleeding have uterine
pathology.
Fibroids are one of the more common causes
of abnormal bleeding. Fibroids are tumors of the uterine
muscle wall. They are almost always benign (not cancer),
but as they enlarge they can distort the uterine cavity
and interfere with the normal function of the uterus, causing
the menstrual periods to become heavy or prolonged.
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Submucosal fibroids arise close to the uterine cavity and
cause distortion related bleeding at smaller sizes than fibroids
that occur further from the cavity. Transvaginal ultrasound
is extremely important in these cases because the uterus is
normal size on exam unless other fibroids are present. |
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Ultrasound pix
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Diagnostic hysteroscopy is the most accurate
way to evaluate the uterine cavity and cervical canal for
fibroids, polyps, and other pathologies that are too subtle
for transvaginal ultrasound to detect.
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Diagnostic Hysteroscopy
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Hysteroscopic view of a normal uterine cavity
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Hysteroscopic appearance
of Intracavitary fibroid & Submucosal fibroid |
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Uterine polyps are tumors of the uterine
lining tissue origin, as they grow into the uterine cavity
they can create abnormal bleeding.
Cervical polyps can also cause abnormal bleeding
and can be found with hysteroscopy.
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Hysteroscopic appearance of
uterine polyp & cervical polyp |
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Adenocarcinoma of the uterus is more of a
concern when abnormal bleeding occurs after the age of 50.
The cancer occurs because estrogen continues to be produced
in usually low levels without progesterone being secreted
by the ovaries. Hysteroscopy directed biopsy can more effectively
diagnose adenocarcinoma and hyperplasia (pre-cancer). Hyperplasia
in many cases can be treated medically, as an alternative
to hysterectomy |
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Adenocarcinoma |
Endometrial Hyperplasia |
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Adenomyosis is also called endometriosis
of the uterine muscle wall. It occurs in approximately 25%
of women during their lifetime and should be considered when
the uterus is enlarged and ultrasound reveals there are no
fibroids. Other less common causes of abnormal bleeding include
endometritis (low grade chronic infection) and adhesions (scar
tissue from a previous uterine surgery). |
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The major reason for abnormal bleeding is ovarian
dysfunction. In young women the ovaries are just
getting started and in older women the ovaries are winding
down. The per menopausal transition usually begins in the
40s but can start in the 30s. Menopause before age 30 is premature.
The uterine lining is stimulated by ovarian estrogen and progesterone.
Fluctuations of these hormones will disrupt the normal process
and can cause prolonged, irregular, or heavy bleeding.
Young women with heavy periods may have a problem with her
clotting factors or platelets. If the internal vascular regulatory
mechanisms of the uterus do not function properly then the
small arteries that supply the uterine lining may not properly
constrict at the time of the menstrual flow and lead to heavier
periods.
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What are the symptoms?
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Heavy menstrual bleeding, which means changing a pad or tampon with soak through every 2 hours or more.
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Periods that last longer than 5-7 days.
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Bleeding or breakthrough bleeding at times other than during
your normal cycle.
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Could it be cancer?
Usually when a woman presents with abnormal bleeding it is due to
benign (not cancer) causes. In cases where the woman is around or
beyond menopause, abnormal bleeding may be an early indication of
uterine cancer. This should be evaluated with hysteroscopy and
directed biopsy. In some cases, pre-cancerous conditions are found.
Precancerous finds can be treated medically and hysterectomy may not
be required. |
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