The uterus bleeds in regular cycles
called the menstrual cycles that last for 3-5 days. Menstruation occurs once
every month although the cycle may vary from 21-35 days. These cyclical
bleeds are triggered by a fall in the oestrogen (female sex hormones) levels
in the blood.
Vaginal bleeding may become abnormally excessive, scanty, or irregular. All
of these need evaluation because they indicate disease.
Causes for Abnormal Vaginal
Bleeding
The bleeding may arise from the
uterus, the cervix, the vagina or the ovaries. In the uterus the
presence of fibroids or cancer cause excessive or irregular
bleeding. Dysfunctional uterine bleeding (DUB) is an irregular
heavy bleeding from a normal uterus, and occurs due to hormonal
imbalances. Other uterine causes include molar pregnancy, double
uterus, infection of the uterus (tuberculosis) and pregnancy
relayed causes such as abortion. An intrauterine copper device may
be the cause if irregular bleeding.
Bleeding from the cervix may occur from erosions, inflammation (cervicitis),
polyps or cancer. Bleeding may arise from the vagina as in vaginal
foreign bodies. Children tend to insert small objects, which stay
in the vagina and cause infection and bleeding. In adults, a
forgotten tampon may be the cause. Other vaginal sources of
bleeding include infections, inflammation in the elderly (senile
vaginitis), and rarely, vaginal cancer.
Some hormone producing tumours of the ovaries can cause bleeding
from the uterus. Bleeding may be less than normal in patients with
hormonal imbalances, such as those that occur at around the time
of menopause. Infections such as tuberculosis, as well as some
drugs (antipsychotic medicines) also may be associated with scanty
blood flow.
What are the symptoms of
abnormal vaginal bleeding ?
Patients may complain of
irregular periods. The cycles may have become shortened. Excessive
bleeding may occur between two menstrual periods or the menstrual
period itself may be profuse, or last longer than normal.
Excessive bleeding may be associated with anaemia. The patients
become pale, and tire easily. Those with tuberculosis or cancer
may have loss of weight.
How is the diagnosis confirmed?
The doctor will first examine the patient with
his fingers, and with a speculum, an instrument to look inside the
vagina and the cervix. If the diagnosis is not clear, other tests
may be needed.
An ultrasound can pick up tumours or enlargement of the ovaries or
the uterus. A Papanicolou (PAP) smear picks up cells from the
cervix and examination of these cells will confirm whether there
is cancer or not. Dilatation and curettage (D&C) is a procedure
that is usually done under anaesthesia. The opening of the cervix
is stretched, and an instrument (curette) is inserted to scrape
the lining of the uterus. This provides tissue for biopsy, which
may reveal an abnormality. In conditions like DUB, a D&C can even
cure the condition.
If the diagnosis is still not clear, the gynaecologist may do a
hysteroscopy. This is a form of endoscopy in which the uterus is
visualised with a specially designed telescope, the hysterosocpe.
The hysteroscopy may be diagnostic, and minor lesions such as
polyps may be removed at the same time. CT scans and MRI may be
required prior to treatment if cancer is suspected or diagnosed,
to identify the extent of disease.
What is the treatment ?
The treatment of abnormal vaginal bleeding
depends on the underlying cause. Medicines are needed for DUB,
which is usually treated with the hormone progesterone (another
female sex hormone), or a hormone-like drug, Danazol. Fibroids are
treated by operation in which either only the fibroid is removed (myomectomy)
or the uterus is removed (hysterectomy). Hysterectomy is preferred
in patients who are not keen to have more children. Anaemia is
commonly present in patients with excessive bleeding, and need
supplementation with iron rich foods such as meat.
When should the doctor be
consulted?
All women with abnormal vaginal bleeding need
medical consultation. Excessive bleeding should be treated early,
and profuse, uncontrollable bleed may need emergency treatment. In
the elderly, abnormal bleeding may indicate cancer, and a thorough
investigation is essential
.
Global Health
Healthcare Provider
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