Irregular Bleeding

Abnormal Vaginal Bleeding

Normal vaginal bleeding (menstruation) occurs every 28 to 35 days in every woman.

Abnormal vaginal bleeding is any bleeding unrelated to normal menstruation.

This can include spotting of small amounts of blood (between periods), or menstrual flow which is heavier than normal.

Causes of Abnormal Bleeding

The causes for abnormal vaginal bleeding rank in risk of occurrence according to women’s age. Some causes are:

  • Hormonal changes - including thyroid disorder
  • Contraception pills or intrauterine device (IUCD)
  • Pregnancy related
  • Infection of the vagina or uterus
  • Problem with blood clotting
  • Cancer of the uterus, vagina or cervix
  • Trauma to the vagina
  • Polyps or fibroids (abnormal outgrowth of tissues or tumours)
  • Certain diseases affecting clotting (eg: Haemophilia)

Symptoms of Abnormal Bleeding

Symptoms of abnormal vaginal bleeding include bleeding between periods or after sex, spotting after menstruation, bleeding heavier or for more days than normal, and bleeding after menopause.

Diagnosis of Abnormal Bleeding

Dr Mariud will examine your family health history as well as complete details of your menstrual cycles (dates, length, and type of bleeding). You will also have a physical examination and blood tests to check your hormonal levels to diagnose the cause of your bleeding.

Dr Mariud may also order a pregnancy test to rule out the possibility of pregnancy. A range of imaging tests such as ultrasound or MRI scans, which produce images of your internal organs, may also be ordered to diagnose irregular bleeding.

A cervical smear and swab may be taken and sent for sampling to determine any abnormalities.

Treatments for Abnormal Bleeding

The types of treatment for abnormal vaginal bleeding are based on many factors such as cause of bleeding, age and whether you want to have a child.

Most cases of abnormal vaginal bleeding can be treated with medications, except for few cases that may require surgery.

Medications for Abnormal Bleeding

Hormonal medications used to treat abnormal bleeding depend on whether or not you want to get pregnant and your age. Hormones can be given as injections, vaginal creams or through intrauterine devices (Mirena).

The hormones are slowly released into the body by these means and control the abnormal bleeding. Dr Mariud may prescribe other medications such as anti-inflammatory drugs or antibiotics to reduce bleeding.

Surgical Treatment for Abnormal Bleeding

Dr Mariud will recommend surgical treatment if the bleeding is caused by:

  • Polyps or Fibroids. Surgery is performed to excise the polyps or fibroids by a procedure called hysteroscopy, which uses a flexible tube or endoscope.
  • Endometrial ablation (burning the lining of the uterus) to reduce bleeding may also be performed. This procedure is reserved for women who finished their family, as accidental pregnancy after this procedure can be complicated. This is a day stay procedure.
  • Hysterectomy (surgical removal of the uterus) may be considered if all other forms of treatments have failed. You can no longer conceive after hysterectomy.

Along with these treatments, you can take good care of yourself by eating a well-balanced diet, exercising and getting a proper amount of sleep.

FIBROIDS

Uterine fibroids are benign lumps in the muscle layer of the uterus. Fibroids are composed of muscle cells and other tissues.  Uterine fibroids are usually round and Fibroids are found in 30-50% of all women.

Types Of Fibroids

Based on their location within the uterus, uterine fibroids can be classified as:

  • Subserosal fibroids: found beneath the serosa (the outer surface of the uterus)
  • Submucosal fibroids: found in the uterine cavity
  • Intramural: found in the muscle wall of the uterus
  • Pedunculated fibroids: Develop on a stalk attached to the outer wall (serosa) of the uterus

Causes For Fibroids

The exact cause for the development of fibroids remains unknown, but some of the proposed causes include:

  • Genetic abnormalities
  • Alterations in expression of growth factor (protein involved in rate and extent of cell proliferation)
  • Abnormalities in the vascular system
  • Tissue response to injury
  • Family history of fibroids

SYMPTOMS OF FIBROIDS

The majority of women with uterine fibroids may be asymptomatic. However, the basic symptoms associated with fibroids include:

  • Heavy menstrual bleeding
  • Prolonged menstrual periods
  • Pelvic pressure or pain, awareness of a pelvic or abdominal mass
  • Frequent urination, difficulty passing urine
  • Constipation
  • Backache or leg pain
  • bleeding between periods,
  • pelvic pain, pain during intercourse
  • Infertility and recurrent miscarriages
  • anaemia due to heavy menstrual bleeding
  • Some women do not have any symptoms (smaller fibroids)

Diagnosis Of Fibroids

The diagnosis of uterine fibroids involves a pelvic examination, followed by ultrasound evaluation. MRI can provide very detailed information on size, and location of fibroids.

Treatments Of Fibroids

Different methods are used for managing uterine fibroids. Surgery is considered the best modality of treatment. The common surgeries performed for the management of fibroids include:

  • Hysteroscopic myomectomy - the removal of fibroid growing in the cavity of the uterus
    • Laparoscopic myomectomy - removal of fibroid in the muscle of the uterus via keyhole surgery. The defect in the uterus is closed with laparoscopic sutures
    • Open multiple myomectomy - removal of 4 or more fibroids followed by reconstruction od the uterus. This is performed as an open (laparotomy) procedure.  
  • Hysterectomy - removal of the uterus
  • Destructive techniques that involve boring holes into the fibroids with a laser or freezing probes (cryosurgery) - not widely used
  • Other techniques employed are uterine artery embolisation (UAE) and uterine artery occlusion (UAO)

Risks During Pregnancy  

The presence of uterine fibroids during pregnancy, depending on their size and location, can increase the risk of complications such as first trimester bleeding, breech presentation, placental abruption, increased chance of Caesarean section and problems during labor.

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