Normal Menstrual Cycle
The menstrual cycle is the changes that occur in a woman’s body as she prepares for pregnancy. Menstrual bleeding, shedding of the uterine lining, occurs about once a month and lasts about four to five days. While normal menstruation occurs on average every 28 days, anywhere from 21 to 35 days between periods is considered normal. Determine when to expect your next period with the Menstrual Calendar.
Abnormal Periods: What is Abnormal Uterine Bleeding?
Abnormal uterine bleeding, also known as abnormal vaginal bleeding or abnormal menstrual bleeding, can occur at any age. Heavy periods and irregular periods can occur at various times in a woman’s life. Between the ages of 9-16, it is common for periods to be irregular. Around the age of 35, the cycle becomes shorter. When a woman is approaching menopause around the age of 50, shorter cycles are normal. It is also normal to have skipped periods or changes in bleeding.
Bleeding in the following manner may be abnormal and require attention:
- Spotting or bleeding between periods
- Spotting anytime in the menstrual cycle
- Post coital bleeding (bleeding after sex)
- Spotting anytime in the menstrual cycle
- Heavy periods or longer periods than normal
- Changing a tampon or pad closer than every 3 or 4 hours
- Blood clots with the period
- Bleeding after menopause has occurred
What Causes Abnormal Uterine or Menstrual Bleeding?
There are many causes of abnormal uterine bleeding. In some women, this occurs because of an imbalance of the hormones estrogen and progesterone. Too much or not enough of one of the hormones that regulates the menstrual cycle can cause abnormal or heavy bleeding. Certain medications or medical problems such as thyroid problems or pituitary problems may contribute to the imbalance. Polycystic Ovary Syndrome (PCOS) or lack of ovulation can cause irregular periods. Recent weight gain or weight loss can cause changes in the bleeding pattern. Excessive exercise can also cause a woman not to have a period, also called amenorrhea, or to become irregular.
Other causes of abnormal uterine or menstrual bleeding include:
- Fibroid Tumors or leiomyomas of the uterus
- Polyps inside the uterus
- Polyps on the cervix
- Ovarian cysts
- Certain types of precancerous or cancer cells, such as cancer of the uterus, cervix or vagina
- Miscarriage
- Pregnancy
- Ectopic Pregnancy
- Infection of the uterus or cervix
- Problems linked to some birth control methods- IUD or birth control pills
- Problems with blood clotting in the body
How is Uterine Bleeding Diagnosed?
Your physician will go over your personal and family history, along with a history of your menstrual cycle. A physical exam and blood work will be completed. Based on the symptoms, further testing may need to be done.
One or more of the following tests may be recommended:
- Ultrasound or pelvic sonogram of the pelvic organs (uterus and ovaries)
- Endometrial biopsy: Tissue is taken from the lining of uterus using a small catheter. Usually an office procedure
- Sonohysterography or hysterosonogram: a special type of pelvic sonogram. Fluid is placed in the uterus through the cervix via a small catheter, while ultrasound images are made. This type of ultrasound allows the doctor to get a better view of the inside of the uterus and help in the diagnosis of polyps and fibroid tumors
- Hysteroscopy: A small, thin telescope is inserted through the vagina and cervix, to view the inside of the uterus.
- Dilation and curettage (D&C): The opening of the uterus is enlarged and a tissue sample is taken. The sample is examined under the microscope. This procedure is painful and therefore done in the hospital under anesthesia. Usually done in conjunction with a diagnostic hysteroscopy when the diagnosis cannot be made in the office.
Treatment Options for Uterine Bleeding
Treatment options will vary and depend on the cause of the abnormal bleeding, your age, and whether you want to have children. If the work up is found to be normal and benign then just observation without intervention may be the best option if the bleeding is not overly bothersome. Patients will always have the choice to observe and not intervene. Medications, such as hormones (birth control pills) or nonsteroidal anti-inflammatory drugs (ibuprofen), the Mirena® IUD with progesterone, or a new medication called Lysteda may help control the heavy bleeding. These minimally invasive treatments can be used long term if needed.
Some women with abnormal uterine bleeding may have a minor surgery without any incisions, where a telescope called a hysteroscope is inserted through the cervix to remove any growths such as polyps or fibroids from the inside of the uterus. An Ob-Gyn physician who possesses special skills and training in this minimally invasive procedure should perform this treatment. Dr Reisler introduced this procedure to the Plano community and has trained other physicians in this and other minimally invasive procedures. Women with fibroid tumors might also be offered a minimally invasive procedure called uterine artery embolization (UAE), which is performed by a radiologist without incisions. Ob/Gyns should refer to other qualified specialists such as radiologists when this is the best option for the patients. Endometrial ablation such as Novasure® Ablation is another minimally invasive day surgery, which may be done to control the heavy bleeding. It is done without any incisions and can be performed in the office or outpatient surgery center. An instrument is inserted through the cervix and the lining of the uterus, called the endometrium, is vaporized and removed. The periods then usually either go away or become very light.
In selected cases hysterectomy may be the best option. And this procedure can usually be performed as a minimally invasive procedure, using small laparoscopic incisions through the abdomen. Two of these procedures are laparoscopic assisted vaginal hysterectomy (LAVH), or laparoscopic supracervical hysterectomy (LASH procedure). In some patients a vaginal hysterectomy, da Vinci Robotic hysterectomy or abdominal hysterectomy might be more appropriate.
A decision of which treatment if any to use should be a decision made by the patient after her physician fully educates her about her unique situation, providing to her all available options (including risk/benefits of all treatments), and after having all questions answered.
Dr. Reisler is a board cetified obgyn specializing in all areas of women’s health, including annual screening for all ages, gynecological problems and their treatments, minimally invasive treatments, normal and high risk pregnancy, and menopause. He offers cutting-edge surgical options, including laparoscopic supracervical hysterectomy, endometrial ablation and other minimally invasive procedures. Dr Reisler has been treating and giving second opinions to patients for 24 years in Plano, Dallas, Frisco, Richardson, Carrollton, Allen, Colony, Wylie, Mckinney, Prosper, Celina, and the surrounding areas.