Problems with bleeding from the vagina are one of the most common reasons why women see their physician. There are many causes for bleeding problems, most of which are benign and easily treatable.

Abnormal menstrual bleeding, also known as abnormal uterine bleeding, is defined as bleeding at irregular intervals (less than 21 day or more than 35 day cycles), bleeding for longer than usual (more than 8 days), or bleeding a larger amount than is typical for a normal menstrual period (greater than 80 mL).

Causes of abnormal menstrual bleeding

The causes of bleeding problems are many and vary with age. They can be divided into pregnancy related bleeding, hormonal imbalances (due to either diseases or contraceptive medications such as the pill), problems of the female internal reproductive organs (such as infections, abnormal growths, and foreign bodies), chronic or severe medical conditions (such as diabetes, severe infections, liver disorders, and others), and general blood disorders.

Diagnosis of abnormal menstrual bleeding

The first thing to do if you seem to have a bleeding problem is see your doctor. They will need to discuss such things as the amount of bleeding, how long it lasts, and how frequently it happens. Your doctor will also ask about other issues, such as the medications you are taking, your sexual practices, your contraception methods, and the symptoms of other diseases that could be related to the bleeding.

After this, your physician will perform a physical examination. This will allow your doctor to both examine your anatomy for a growth, cut, or infection causing the bleeding, and to do a full examination in search of other syndromes that may be causing the bleeding.

Depending on your age and the results of your examination, your doctor will determine which other tests may be necessary, including imaging studies such as ultrasound, X-ray, biopsy, and tests for sexually transmitted infections.

Other tests which your physician will likely order are laboratory studies such as blood tests. With these, one can search for such causes of bleeding as coagulation disorders or "thin" blood, thyroid disease, liver disease, infection, and pregnancy.

Treatment of abnormal menstrual bleeding

Treatment for bleeding problems focuses on the cause of the bleeding, as determined by the history, findings from the physical examination, and the tests noted previously.

  • An infection is usually curable with antibiotics.
  • Surgery may be an option for an abnormal growth (e.g., fibroid).
  • If the problem is one of hormones and ovulation (so-called "dysfunctional uterine bleeding"), several medical therapies are available, ranging from medications that decrease bleeding to those which can correct hormonal imbalances and allow the return of a typical menstrual cycle.
  • Pregnancy-related conditions that produce bleeding require special attention to make certain that the pregnancy continues to be a healthy and normal one.
Zachary Levine, MD 
in association with the MediResource Clinical Team