Abnormal Menstrual Bleeding
The menstrual cycle depends on the precise sequence of hormones coming from the brain to the ovaries. A disruption in this sequence can cause menstrual irregularity. In addition, anatomic problems such as a polyp or a fibroid (both benign) can cause irregular or heavy bleeding (menorrhagia). Pregnancy and infection can also lead to abnormal bleeding.
It is very helpful to keep a log of your bleeding and bring it to your appointment. Record details such as spotting, medication usage, and pelvic pain. You can expect your doctor or practitioner to take a careful history, perform an examination, and possibly order labs and/or an ultrasound. In some cases, an endometrial biopsy is performed. This is a simple office procedure where a tiny tube is passed through the cervix and suction is used to obtain a sample of the tissue inside of the uterus. Most women tolerate this quite well.
When should you be concerned and make an appointment?
- If periods have not begun by age 16. This is called primary amenorrhea. There are a number of possible causes including hormonal, anatomic, or simply delayed puberty. Your provider will take a careful history, perform an examination, and order some lab tests. Imaging tests such as an ultrasound are sometimes ordered. Treatment, if any, is recommended after the results of the tests are known.
- If your periods are closer together than every 24 days or you have bleeding in between cycles. This is called polymenorrhea or metrorrhagia. Hormonal causes as well as anatomic problems such as polyps are often found.
- If your periods are further apart than 35 days. This is called oligomenorrhea. There are many potential causes including hormonal issues such as thyroid problems, stress, polycystic ovarian syndrome, and perimenopause.
- If you once had periods but now haven’t had one in more than 3 months. This is called secondary amenorrhea. One of the most common causes of this is pregnancy. If you have had sexual intercourse since your last period, you may want to take a home pregnancy test. Other causes include stress or other hormonal issues such as polycystic ovary syndrome and perimenopause/menopause.
If your periods seem excessively heavy. This can be hard to quantify, but if they seem excessive to you (for example, you need to change products more than once per hour or you are routinely bleeding through clothes), it is recommended that you see one of our providers to determine if there is a cause, and to get recommendations for possible treatments. If the cause is determined to be a polyp or a fibroid, these can often be removed. If no anatomic cause is found, treatments include hormonal options such as oral contraceptive pills, the Mirena IUD (contains progesterone), or an endometrial ablation procedure called Novasure.
Finally, vaginal hysterectomy may be the treatment option for many patients.
Bleeding after menopause. This should always be evaluated. Possibilities include polyps, an overgrowth of the lining of the uterus called hyperplasia, or an endometrial cancer. Treatments are specific to the diagnosed problem.