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Abnormal vaginal menstrual bleeding is a common condition. From one woman to the next, the problem varies according to the volume of the bleeding, the pattern of occurrence relative to the menstrual cycle and the regularity of the abnormal bleeding from one month to the next.

For patients who experience abnormal bleeding, gynecologists at Virtua are committed to finding the cause. They can almost always offer treatment to correct or reduce the problem.

Until most adult women reach menopause, they experience menstrual bleeding every 21 to 28 days during their menstrual cycle, with the bleeding lasting for a week or less. But many women may have more than one cycle of bleeding per month, or they have bleeding that is heavy or irregular or prolonged (lasting for more than seven days). These abnormal cycles of menstruation can first take place at any age and can occur predictably or sporadically.

Many Causes for Which to Seek Care

Possible causes of abnormal bleeding.
© 2011 Intuitive Surgical, Inc.

Many conditions that compromise the anatomy of the uterus or that disrupt ovulation, can lead to heavy bleeding. These conditions include uterine fibroids and endometrial polyps, or occassionally endometriosis, as well as endocrine (hormonal) abnormalities and cancer. When abnormal growths push or protrude into the uterine cavity, they can cause heavy or prolonged vaginal bleeding, or can bring on spotting and bleeding in between periods. Hormonal imblances (see side bar) can cause heavy and abnormal bleeding, as can chronic disorders that cause wider systemic or metabolic disruptons such as kidney problems, congestive heart failure or severe diabetes.

Women usually know when something seems abnormal in their menstrual cycle. Bleeding in-between cycles, bleeding that is difficult to manage and bleeding after menopause are abnormal patterns. Women who sense a problem should be evaluated.

They should consult with their gynecologist to seek diagnosis and treatment. Virtua’s well-trained, experienced gynecologists can often identify or confirm the causative conditions at the time of taking a patient’s initial history and physical examination. They will discover the reason for the great majority of heavy and irregular vaginal bleeding by gathering this information in conferral with the patient and with an adequate medical work-up, which can include various tests.

Hormonal abnormalities and heavy bleeding
In about 40 percent of patients with heavy bleeding, an imbalance in hormones produced by the ovaries or glands such as the thyroid, pituitary and adrenals is the basis of the problem.  Insulin resistance also triggers overproduction of testosterone from the ovaries, which can lead to menstrual disruption. Women who chronically do not ovulate usually have irregular periods, often going for long periods of time between menstruation and then bleeding heavily for as long as two to three weeks, sometimes passing large clots. Simple tracking of basal body temperature can confirm a lack of ovulation. If the cause is hormonal imbalance, Virtua’ gynecologists can use medical ovulation treatments to resolve the problem. Often this means, progesterone supplementation, the result of which is usually a return to regular, controlled vaginal bleeding.

Medical, Interventional and Surgical Options

Most causes of abnormal menstrual bleeding are correctable. Medical treatment in most cases will suffice.

When needed, other nonmedical options are also available, including conservative, minimally invasive interventions, mostly commonly endometrial ablation.

Surgery –– including, at Virtua, with use of robotic technology –– serves to correct the causative problems in many women. Hysterectomy (surgical removal of the uterus) is, of course, the safe, definitive and permanent step for terminating menstruation. Only if other solutions have failed and the bleeding continues, does the Virtua team discuss hysterectomy as an option.

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