What is considered abnormal bleeding?
A normal menstrual cycle lasts from 24 to 38 days, menstruation lasts up to 8 days, and the amount of blood lost does not disrupt normal life. Deviations from these parameters are considered abnormal uterine bleeding and require examination.
- Heavy periods requiring pad changes every 1–2 hours
- Menstruation longer than 8 days
- Cycle shorter than 24 or longer than 38 days
- Bleeding between periods
- Bloody discharge after sexual intercourse
- Bleeding in postmenopause
Reasons
For convenience, doctors divide the causes into structural, visible during examination, and non-structural - functional and systemic. One woman may have a combination of several reasons.
- Polyps of the endometrium and cervical canal
- Adenomyosis
- Uterine fibroids
- Endometrial hyperplasia and malignant tumors
- Bleeding disorders, taking anticoagulants
- Lack of ovulation: adolescence, premenopause, PCOS, hyperprolactinemia, hypothyroidism
- Chronic endometritis
- Intrauterine device, hormonal contraceptives
- Complications of pregnancy
Symptoms and consequences
The main danger of prolonged heavy bleeding is iron deficiency anemia, which develops gradually and which women often do not notice. Acute heavy bleeding can quickly lead to dangerous blood loss.
- Heavy or prolonged bleeding
- Irregular cycle
- Weakness, fatigue, pallor
- Dizziness, shortness of breath on exertion
- Hair loss, brittle nails due to iron deficiency
Diagnostics
First of all, pregnancy is excluded. Then the gynecologist conducts an examination and prescribes an ultrasound of the pelvic organs, preferably transvaginal. Blood tests help assess the degree of anemia, thyroid function and clotting. Women over 45 years of age and with risk factors for endometrial hyperplasia undergo endometrial biopsy or hysteroscopy with tissue examination.
- Pregnancy test or hCG
- Gynecological examination, smear for oncocytology
- Transvaginal ultrasound
- Complete blood count, ferritin
- TSH, prolactin, according to indications - sex hormones
- Hemostasiogram
- Pipelle endometrial biopsy, hysteroscopy
Treatment
In case of acute heavy bleeding, the task is to quickly stop it: hormonal and hemostatic drugs are used, if ineffective or in older women, hysteroscopy with curettage is used. Further treatment depends on the cause and plans for pregnancy: hormonal contraceptives, progestins, intrauterine system with levonorgestrel, non-hormonal drugs that reduce blood loss. Polyps are removed hysteroscopically, fibroids - according to indications. Anemia is corrected with iron supplements. All medications are prescribed by a gynecologist.
- Keep a calendar of menstruation and note abundance
- Do not delay your visit if you are bleeding between periods
- Check hemoglobin and ferritin levels
- Maintain a normal weight
- Have an annual examination with a gynecologist
