Abnormal uterine bleeding is the most common reason for gynecologic surgery in premenopausal women. Dysfunctional uterine bleeding is another term used to describe this problem. Uterine bleeding is considered to be abnormal if the menses (period) occurs more frequently, last longer than usual or if the amount of bleeding is much heavier than normal.

Periods typically occur every 24-35 days and last 5-7 days. Average blood loss during this time is usually 80 ml. More frequent bleeding, longer periods and blood loss in excess of 100 ml per cycle can lead to anemia. Symptoms of anemia include lack of energy, fatigue, pica, headaches, palpitations and fainting. In severe cases a stroke or heart attack might occur. For many women, this heavy bleeding is accompanied by other bothersome symptoms such as “labor like” cramps, back pain, fatigue, bloating, irritability and difficulty concentrating.

Excessive bleeding can be annoying, distressful, and expensive. Wearing a tampon or pad for long periods and changing them constantly can be uncomfortable and disruptive to one’s work and social life. Heavy bleeding can also create anxiety over the cause of the abnormal flow. Finally, purchasing excessive amounts of sanitary products can take a big bite out of one’s wallet.

An evaluation by a health care provider is recommended to determine the cause of the abnormal bleeding and to recommend ways to manage it. The first test should be a pregnancy test since an abnormal pregnancy is a common cause of irregular bleeding. Once this is eliminated as a possible explanation, the next consideration is a malignancy. This is a diagnosis that Gynecologists do not want to miss! In women over 35 an endometrial biopsy or dilatation and curettage might be recommended to evaluate this possibility. This is infrequently found but an early diagnosis can be life saving.

The major cause of abnormal bleeding is usually hormonal or anatomic. A woman might have excessive amounts of estrogen in her blood stream suppressing ovulation and stimulating the lining of the uterus to continue to grow. Once the lining decides to shed the bleeding is uncontrolled. The excessive estrogen can be produced in the body when there is too much fat tissue or it can be introduced in the body from hormonal medication such as birth control pills or as environmental contaminates found in foods like hormonally fed beef and chicken. Anatomical factors include uterine fibroids and endometrial polyps. Fibroids are noncancerous tumors that grow in the muscular uterus. A polyp is a finger like soft tissue structure that grows in the lining of the uterus. They both interfere with the muscular contraction of the uterus preventing it from clamping down on the blood vessels thereby controlling blood loss. They both can also interfere with the phasic growth of the endometrial lining resulting in dysynchronous shedding.

A comprehensive medical evaluation is needed to discover the cause of the irregular bleeding and to provide effective treatment options. A Gynecologist should take a thorough history and perform a detail examination. Laboratory and radiological test might be ordered to assist in the evaluation. Treatment options may include medication or surgery.

Stay tuned for future articles that will detail evaluation and treatment options.