Abnormal Vaginal Bleeding…What You Need To Know…
Posted on 14. Nov, 2011 by afyakenya in Blog
Menorrhagia is defined as menstruation at regular cycle intervals but with excessive flow and duration and is one of the most common gynecologic complaints in contemporary gynecology.
A normal menstrual cycle is 21-35 days in duration, with bleeding lasting an average of 7 days and flow measuring 25-80 mL.
Menorrhagia must be distinguished by your gynecologist from other common gynecologic problems. These include metrorrhagia (flow at irregular intervals), menometrorrhagia (frequent, excessive flow), polymenorrhea (bleeding at intervals of less than 21 days), and dysfunctional uterine bleeding (abnormal uterine bleeding without any obvious structural or systemic abnormality).
It is important to exclude pregnancy in women who present with such bleeding. This is the most common cause of irregular bleeding in women of reproductive age. Pregnancy should be the first diagnosis to be excluded before further testing or medications are instituted.
Quantity is a very subjective issue when considering vaginal bleeding. Best estimates usually are the only source your healthcare provider will have available to consider. Helpful references for totaling blood loss may include that the average tampon holds 5 mL and the average pad holds 5-15 mL of blood. The patient is asked what type of pad (liner vs overnight) was used and if it was soaked may add some insight into what the patient believes to be heavy bleeding. Quality of bleeding involves the presence of clots and their size.
Young patients, from menarche (which is the age at which the woman has her first period) to the late-teen years, most commonly have anovulatory bleeding (which means an infertile flow) due to the immaturity of their hormone system responsible for reproduction. If bleeding does not respond to usual therapy in this age group, a bleeding disorder must be considered.
Women aged 30-50 years may have organic or structural abnormalities. Fibroids or polyps are frequent anatomical findings. Organic causes can be anything from thyroid dysfunction to kidney failure.
Postmenopausal women with any uterine bleeding should receive an immediate workup for endometrial cancer.
If a young patient has had irregular menses since menarche, the most common etiology of her bleeding is anovulation. Anovulatory bleeding is most common in young girls (aged 12-18 y) and common in obese females of any reproductive age.
If a patient’s bleeding normally occurs at regular intervals and the irregularity is new in onset, illness must be ruled out, regardless of age.
Simple vaginitis (eg, candidal, bacterial vaginosis) may cause intermenstrual bleeding, while gonorrhea and chlamydia may present with heavier bleeding attributed primarily to the copious discharge mixed with the blood.
Chlamydia is a common cause of postpartum endometritis, leading to vaginal bleeding in the weeks following a delivery. A postpartum infection (eg, endometritis) also may be due to organisms unrelated to sexual activity.
It is also important to consider contraceptive use (intrauterine device or hormones.) Commonly, an intrauterine device (IUD) causes increased uterine cramping and menstrual flow. If a patient has recently discontinued birth control pills, she may return to her “natural” menses and report an increase in flow. This actually is normal because most oral birth control pills decrease the flow and duration of a woman’s menses.
Kind regards,
Oduwo Noah Akala
Executive Chairman,
Afya Kenya Foundation.
n.oduwo@afyakenyafoundation.org
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