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Abnormal Uterine Bleeding
Abnormal bleeding includes bleeding that is prolonged (longer than a woman’s normal menstrual period), too frequent (less than 21 days from the first day of one episode of bleeding to the first day of the next) or heavier than usual (or requiring more than a pad every hour during the heaviest time). There are many reasons for abnormal uterine bleeding and these can be sub-divided into two main groups: hormonal imbalance causing ovulatory problems and abnormalities of the vagina, cervix or uterus. The latter group of abnormalities include infections, polyps, uterine fibroids and cancer.
Abnormalities of the Vagina and Cervix
Infections or other conditions of the vagina and cervix sometimes can cause bleeding, though usually this is light and may be associated with intercourse. Post-menopausal women sometimes can have thinning of the vaginal walls that can lead to light bleeding. Abnormalities of the cervix, including cervical cancer, also can cause bleeding. These conditions can be diagnosed by physical examination and office tests.
These are benign growths in the uterine lining that can lead to irregular uterine bleeding. They can be removed by hysteroscopy, a procedure during which a slender “telescope” is inserted through the vagina and cervix into the uterine cavity to allow examination of the cavity and removal of the polyps.
In women who have experienced menopause, abnormal bleeding can sometimes be a sign of endometrial cancer or cancer of the lining of the uterus. This usually can be diagnosed by tests done as day surgery procedure, including an endometrial biopsy in which some cells are removed from the endometrium. Endometrial cancer can be treated with surgery if diagnosed early.
A medical history and gynaecologic examination are useful in identifying the cause of abnormal uterine bleeding. Usually, hormonal tests and ultrasound examination are needed. Tests for infections may be indicated depending on the clinical findings. Hysteroscopy, a procedure during which a small viewing instrument is placed into the uterine cavity in order to examine the cavity, is often helpful. Hysteroscopy is usually coupled with curettage whereby a small amount of tissue can be removed from the uterine cavity to assist in making a diagnosis.
Absent Menstrual Periods
Missing or absent menstrual periods, when not due to pregnancy, usually have a hormonal cause. One common cause amongst young women is polycystic ovarian syndrome (PCOS). This is a hormonal disorder in which a woman’s body produces abnormally high levels of the male hormone, called androgens. These high levels of androgens prevent the ovaries from producing enough progesterone, which is necessary for a normal menstrual cycle. This results in undeveloped egg follicles, which turn into small cysts in the ovaries that prevent ovulation.
Another common cause of missing menstrual periods especially amongst older women is menopause, in which a woman stops having periods because her ovaries are no longer producing oestrogen. Other reasons for absent menstrual periods include lack of ovulation due to causes other than PCOS, excess prolactin secretion by the brain, thyroid disorders, eating disorders and excessive exercise. Rarely, absent menstrual periods can be caused by scarring of the uterine cavity as a result of a medical curettage procedure.
The reason for absent or infrequent menstrual periods usually can be determined by the combination of a medical history, physical examination, gynaecological ultrasound scan and blood tests.
Treatment options depend on the cause of the infrequent or absent menstrual periods. Treatment can involve lifestyle changes such as moderation of diet or exercise habits and hormonal medication such as oral contraceptive pills, thyroid medication or oestrogen replacement therapy.