Treating abnormal vaginal bleeding

Abnormal vaginal bleeding is a common concern that affects women of all ages. It is characterised by bleeding that is irregular in volume, timing or duration and may occur outside of a normal menstrual cycle. Understanding the causes and treatment options is essential for effective management, as abnormal bleeding can sometimes signal underlying health issues.

What causes abnormal vaginal bleeding?

Abnormal bleeding can arise from various gynaecological and non-gynaecological conditions. Some common causes include:

• Hormonal imbalances: These can disrupt the menstrual cycle and lead to irregular bleeding, often linked to polycystic ovary syndrome (PCOS), thyroid disorders or menopause.
• Uterine abnormalities: Fibroids, polyps, adenomyosis, or endometrial hyperplasia may cause excessive or irregular bleeding.
• Infections: Pelvic inflammatory disease (PID) or sexually transmitted infections (STIs) can cause bleeding between periods.
• Pregnancy-related issues: Miscarriage, ectopic pregnancy, or implantation bleeding may result in abnormal vaginal bleeding.
• Cancers: Endometrial, cervical or ovarian cancers should be considered in cases of postmenopausal or unexplained bleeding.

How is abnormal bleeding diagnosed?

Accurate diagnosis is crucial to determine the underlying cause and guide treatment. The diagnostic process typically includes:

• Medical history: Information about menstrual patterns, sexual health and any associated symptoms.
• Physical examination: A pelvic examination to identify signs of infection, structural abnormalities or bleeding sources.
• Imaging tests: Ultrasound, particularly transvaginal ultrasound, helps assess uterine and ovarian structures.
• Laboratory tests: Blood tests to evaluate hormone levels, thyroid function, and blood clotting.
• Biopsy: Endometrial biopsy may be performed to rule out cancer or pre-cancerous changes.

Treatment options for abnormal vaginal bleeding

The treatment for abnormal vaginal bleeding depends on the underlying cause, the severity of the symptoms, and the patient’s age and reproductive goals.

1. Medications

• Hormonal therapies:
  • Combined oral contraceptives or progestin-only pills help regulate menstrual cycles and control bleeding.
  • Hormonal intrauterine devices (IUDs), such as the Mirena coil, reduce heavy bleeding and may address underlying endometrial issues.
• Non-hormonal options:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen reduce blood loss and relieve menstrual cramps.
  • Tranexamic acid can help minimise heavy bleeding during menstruation.
• Antibiotics: Used to treat infections, such as PID, that may contribute to bleeding.

2. Minimally invasive procedures

• Endometrial ablation: A procedure that removes or destroys the uterine lining to reduce heavy menstrual bleeding. It is suitable for women who do not wish to have more children.
• Hysteroscopy: A diagnostic and therapeutic procedure to remove uterine polyps or fibroids.

3. Surgical options

• Myomectomy: Removal of fibroids while preserving the uterus, ideal for women who plan to conceive.
• Hysterectomy: Complete removal of the uterus may be recommended for severe cases of abnormal bleeding, such as those caused by cancer or persistent fibroids.

When to see a gynaecologist

It is essential to consult a gynaecologist if abnormal vaginal bleeding occurs with:

• Heavy bleeding that soaks through pads or tampons within an hour.
• Bleeding after menopause.
• Irregular bleeding between periods.
• Severe pelvic pain or discomfort.
• Symptoms of anaemia, such as fatigue or shortness of breath.

Importance of individualised care

Every patient’s situation is unique, and treatment plans should be tailored to address the specific cause of bleeding while considering the patient’s preferences and long-term health goals. By seeking timely medical advice and undergoing appropriate treatment, women can manage abnormal vaginal bleeding effectively and improve their quality of life.