Abnormal Uterine Bleeding

This category of menstrual bleeding contains a long list of various types of abnormal vaginal bleeding and can be due to a number of different causes. The table below defines a number of common abnormal bleeding types.

About 25% of abnormal uterine bleeding are due to organic reasons while 75% are due to functional reasons (=dysfunctional uterine bleeding). As a woman ages, there is a higher risk that an organic problem such as adenomyosis, endometriosis and gynecological cancer (uterine cancer, cervical cancer or ovarian cancer) can cause an abnormal uterine bleeding. Uterus fibroids are common beyond the age of 40 where about 40% of women have them. Only a small percentage of them cause abnormal bleeding, but if they do a hysterectomy may be required.

Postmenopausal bleeding

In postmenopausal bleedingthe gynecologist must make every effort to rule out a hidden cancer. Usually a diagnostic D&C is done and possibly an MRI scan. The specialist may also decide to do a
diagnostic laparoscopy, if ovarian pathology or endometriosis is suspected.

Bleeding during early pregnancy

Bleeding in an early pregnancy is a potentially dangerous condition.

An enlarged uterus can be due to hormone changes of pregnancy when the blood vessels are engorged and bleeding bleeding after a miscarriage (medically known as "spontanous abortion") can be profuse, causing severe anemia.

This can be life threatening and needs immediate intervention with a D&C (dilatation of the cervix and curretage of the uterus) by a specialist. For every life birth there is a miscarriage, in other words half of all pregnancies never make it to completion.

It is important to ensure that all of the fetal tissue and retained placental tissue is removed in these situations, otherwise there is the risk of developing a choriocarcinoma or a hydatiforme mole. Although early pregnancy associated bleeding is often devastating to a couple, as dreams of family are preliminarily shattered, it is not all bad news. We could perhaps rethink our perception about nature and realize that in some instances nature wants to mature the uterus more, so with the next attempt it is more ready to carry through the pregnancy.

In other cases there may be lethal mutations or genetic malformations that are incompatible with life and nature decides to spontaneously abort this pregnancy. We need to overcome the human tendency to lay blame onto the husband's sperm or the mother's egg. The truth is that very often the cause cannot be determined, so we are better off to simply accept and then when we are emotionally ready to simply try again. One thing seems to be for certain namely that every new pregnancy gives the uterus a boost and makes the woman more fertile for about one year.

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

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Last Modified: March 3, 2012