The menstrual cycle is not the same for every woman. On average, menstrual flow occurs every 28 days (with most women bleeding every 24 – 34 days), and lasts about 4-7 days. There is a large variation among women that may still be normal.
Abnormal bleeding may present as:
- Spotting or bleeding in between periods
- Bleeding after sex
- Bleeding heavily (may involve the passage of clots, require changing of pads or tampons at night or every hour)
- Bleeding longer then 7 days
- Menstrual cycles less than 28 days or longer than 35 days
- Bleeding after you have gone through menopause
The causes of abnormal bleeding are also varied. A common cause is an imbalance in the level of hormones. This is particular true for young women who have only started having periods and women who are close to menopause.
Other causes include:
- Uterine fibroids, Endometrial polyps or adenomyosis
- Endometrial hyperplasia (an overgrowth of the uterine lining)
- Endometrial or cervical cancer
- Infection in the uterus (endometritis)
- Recent trauma or surgery
- Recent change in hormonal tablets such as the contraceptive pill
- Use of IUD or other contraceptive devices
- Use of certain drugs such as blood thinners
- Certain medical conditions such as thyroid disease or systemic lupus erythromatosis (SLE)
- Bleeding disorders e.g. Von Willebrands
- Stress, change in diet or exercise routine, recent weight loss or gain, travel or illness
Determining the cause of your abnormal bleeding requires a thorough history and examination. It may be useful to keep a diary of your bleeding and cycles. Further investigations would include blood tests, Pap smear, ultrasound and occasionally sampling of the lining of the uterus.
Endometrial sampling may be done in the practice rooms via a Pipelle or in theatre by way of a Hysteroscopy and Curettage. A pipelle uses a thin plastic tube to pass through the cervix and into the uterine cavity where a sample is obtained.
Treatment will be directed at the cause of your bleeding. Treatment options can be separated into non-surgical and surgical. Depending on the cause, your desire for future fertility and your general health will determine the best option.
If you have any concerns regarding your menstrual cycles, please contact the practice to make an appointment. Dr Kylie Isaacs respectfully and sensitively work to determine the diagnosis and initiate the appropriate management.