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Abnormal Uterine Bleeding

Abnormal uterine bleeding is a category of menstrual bleeding containing a long list of various types of abnormal vaginal bleeding. This can be due to a number of different causes, which are listed below.

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 physical problem such as adenomyosis, endometriosis and gynecological cancer (uterine cancer, cervical cancer or ovarian cancer) would cause an abnormal uterine bleed. 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. Below there are links to various websites with more detailed information and links to my own chapters within nethealthbook.

Types of abnormal uterine bleeding

Medical term: Explanation:
bleeding with early pregnancy often associated with spontaneous abortion (loss of pregnancy)
hypermenorrhea excessive amount of bleeding
menorrhagia excessive duration of period
metrorrhagia (or intermenstrual bleeding) bleeding between two periods
polymenorrhea frequent menstruations
postmenopausal bleeding any bleeding more than 6 month after the last normal period
bleeding from uterine fibroid fibroids can cause excessive bleeding

 

Postmenopausal bleeding

In postmenopausal bleeding the 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 (thanks to http://mcancer.org/for this link), 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 “spontaneous 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 curettage 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 hydatiform 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.

 

References:

1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse  Station, N.J., 1999. Chapter 235.

2. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper  Collins, 1997.

3. Ryan: Kistner’s Gynecology & Women’s Health, 7th ed.,1999 Mosby,  Inc.

4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse  Station, N.J., 1999. Chapter 245.

5. AB Diekman et al. Am J Reprod Immunol 2000 Mar; 43(3): 134-143.

6. V Damianova et al. Akush Ginekol (Sofia) 1999; 38(2): 31-33.

7. Townsend: Sabiston Textbook of Surgery,16th ed.,2001, W. B.  Saunders Company

8. Cotran: Robbins Pathologic Basis of Disease, 6th ed., 1999 W. B.  Saunders Company

9. Rakel: Conn’s Current Therapy 2001, 53rd ed., W. B. Saunders Co.

10. Ruddy: Kelley’s Textbook of Rheumatology, 6th ed.,2001 W. B.  Saunders Company

11. EC Janowsky et al. N Engl J Med Mar-2000; 342(11): 781-790.

12. Wilson: Williams Textbook of Endocrinology, 9th ed.,1998 W. B.  Saunders Company

13. KS Pena et al. Am Fam Physician 2001; 63(9): 1763-1770.

14. LM Apantaku Am Fam Physician Aug 2000; 62(3): 596-602.

15. Noble: Textbook of Primary Care Medicine, 3rd ed., 2001 Mosby,  Inc.

16. Goroll: Primary Care Medicine, 4th ed.,2000 Lippincott Williams &  Wilkins

17. St. Paul’s Hosp. Contin. Educ. Conf. Nov. 2001,Vancouver/BC

18. Gabbe: Obstetrics – Normal and Problem Pregnancies, 3rd ed.,  1996 Churchill Livingstone, Inc.

19. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse  Station, N.J., 1999. Chapter 251.

20. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse  Station, N.J., 1999. Chapter 250.

21. Ignaz P Semmelweiss: “Die Aetiologie, der Begriff und die  Prophylaxis des Kindbettfiebers” (“Etiology, the Understanding and  Prophylaxis of Childbed Fever”). Vienna (Austria), 1861.

22. Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th  ed., 1998 Mosby-Year Book, Inc.

23. Mandell: Principles and Practice of Infectious Diseases, 5th ed.,  2000 Churchill Livingstone, Inc.

24. Horner NK et al. J Am Diet Assoc Nov-2000; 100(11): 1368-1380.

Last modified: December 18, 2016

Disclaimer
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.