Diagnosing and Treating Abnormal Bleeding

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Joseph.Jerry Presidential Headshot 2009By Gerald F. Joseph, Jr, MD, president of the American College of Obstetricians and Gynecologists

The average menstrual period lasts between three and seven days with about 21 to 35 days in between each menstrual cycle. However, some women experience bleeding more often than every 21 days, extremely heavy bleeding, a menstrual period that lasts seven days or longer, or a combination of these problems. In fact, bleeding that is not part of a normal period is the reason for more than 1.4 million ob-gyn visits each year.

It can be hard to pinpoint the source of the bleeding; the vulva, vagina, cervix, uterus, urinary tract, or rectum may be involved. In adolescents, common causes of bleed-ing include missed ovulation which may be related to a young, immature ovulatory system, stress, or polycystic ovarian syndrome (PCOS); contraception, pregnancy, or blood disorders such as von Willebrand disease. Abnormal bleeding in older women is most often related to pregnancy, noncancerous masses such as fibroids and polyps, and missed ovulation caused by PCOS, hormone therapy, or problems with the lining of the uterus (endometrium). Infection or trauma, which may be a sign of rape or abuse, may also factor in to the unexplained bleeding. A physical exam and blood tests may be used to diagnose a woman’s specific problem.

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Cancer of the endometrium is sometimes the cause of bleeding in menopausal women and may be a factor for younger women as well, although endometrial cancer in women younger than 35 is rare. An endometrial assessment should be performed in any woman older than 35 with abnormal bleeding to rule out cancer. Some patients between 19 and 35, such as those who do not respond to medical therapy for abnormal bleeding, should also be assessed.

Hormonal medications such as birth control pills, cyclic progestin, or progestin-containing intrauterine devices can help regulate menstrual periods and are typical treatments for abnormal bleeding. Other drugs, such as ibuprofen, may be used to relieve cramps. You will be prescribed antibiotics if an infection is to blame. Women who no longer desire to have children may also consider a hysterectomy or a procedure called endometrial ablation, which may be an efficient and cost-effective alternative to hysterectomy.

Any bleeding that is not related to your menstrual period is not normal. Talk to your doctor if this happens to you. He or she can assess how much and how often bleeding occurs, your age, health status, plans for having children, and other disorders that could be contributing to your condition. This information can be used to develop a management plan to treat the underlying cause.

For more information, the ACOG Patient Education Pamphlet “Abnormal Uterine Bleeding” is available in English and Spanish at www.acog.org/publications/


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