The three main classifications of abnormal bleeding are as follows:
- Metrorrhagia: Irregular bleeding that occurs between periods
- Menorrhagia: Heavy blood flow that occurs during periods, such as passages of clots or menses that last longer than seven days
- Menometrorrhagia: A combination of Metrorrhagia and Menorrhagia, in which the irregular blood flow occurs between periods and is heavier and lasts longer than usual during periods.
In women that are pre-menopausal, the cause of abnormal bleeding is primarily hormone imbalance. The most common hormonal imbalance that produces abnormal bleeding is an ovulatory cycle. An ovulatory cycle is a menstrual cycle in which the egg is not released, which leads to fluctuating levels of estrogen and absent progesterone production. This, in turn, leads to irregular proliferation and the breakdown of the uterine lining, causing abnormal bleeding patterns.
There are a variety of reasons for hormone imbalances.
- Stress: Stressful life events, like moving, illness, school, failing a test, or experiencing relationship issues can lead to hormonal changes in the body, which can in turn affect the menstrual cycle.
- Weight changes: Gaining or losing weight can have large effects on hormones.
- Age extremes: Often, the hormonal changes are brought on by natural causes associated with age. Young girls, who are first experiencing puberty, have immature systems, which are susceptible to irregular bleeding. Likewise, older women, who might still have eggs, don’t always produce normal hormonal levels, which can also cause abnormal bleeding.
- Irregularities in thyroid hormone production: can also be an underlying cause of an ovulation.
- Other illnesses: can affect the regularity of ovulation and lead to irregularities in bleeding patterns.
Abnormal bleeding can also be the result of pelvic pathology, including cervical disease, uterine polyps and/or fibroids, cancer, and ovarian cysts. If specific pelvic pathology is diagnosed, then treatment of those conditions usually corrects the problem.
Evaluation consists of a history and physical exam and usually a pelvic ultrasound. On occasion, other tests may be obtained, such as blood tests, CT-scans, and MRIs. If no abnormalities are detected, then by elimination, the cause is hormonal imbalance.
If stress and/or weight fluctuations are the problems, simple corrective lifestyle changes can alleviate them. If the abnormal bleeding symptoms are new and not due to pelvic pathology, there is a high chance of self-correcting. If the problem persists, birth control or other hormonal therapies are extremely effective methods for controlling and stopping abnormal bleeding. Because they are close to 100 percent effective, if they do not work to stop the bleeding, the initial diagnosis should be re-evaluated.
Abnormal uterine bleeding should be checked by a gynecologist. If the evaluation does not reveal pelvic pathology, there are a number of medications and lifestyle changes that can be performed to stop the abnormal bleeding.