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Uterine Bleeding

Signs and Symptoms

Abnormal uterine bleeding can occur for a number of reasons: Problems with ovulation, a hormonal imbalance or abnormalities of the vagina, cervix or uterus. Abnormalities of the uterus leading to abnormal bleeding include uterine fibroids and cancer of the endometrium, the uterine lining.

Common Reasons for Abnormal Uterine Bleeding

Anovulation

Lack of normal cyclic bleeding due to problems with hormone secretion by the ovary. This usually can be diagnosed by a history and physical examination. Blood tests for hormone levels are sometimes helpful. Treatment usually involves correcting the hormonal imbalance with medication.

Abnormalities of the vagina and cervix

Infections or other conditions of the vagina and cervix sometimes can cause bleeding, though usually this is light and may be associated with intercourse. Post-menopausal women sometimes can have thinning of the vaginal walls that can lead to light bleeding. Abnormalities of the cervix, including cervical cancer, also can cause bleeding. These conditions can be diagnosed by physical examination and office tests.

Uterine fibroids

Fibroids are non-cancerous (benign) growths that develop within the uterus. Most women with fibroids have no symptoms and don't need treatment. When symptoms occur, women should seek medical attention.

Endometrial polyps

These are benign growths in the uterine lining that can lead to irregular uterine bleeding. They can be removed by hysteroscopy, a procedure during which a slender "telescope" is inserted through the vagina and cervix into the uterine cavity to allow examination of the cavity and removal of the polyps.

Endometrial cancer

In women who have experienced menopause, abnormal bleeding can sometimes be a sign of endometrial cancer, or cancer of the lining of the uterus. This usually can be diagnosed by tests done in the office, including an endometrial biopsy in which some cells are removed from the endometrius. Endometrial cancer can be treated with surgery if diagnosed early.

Abnormal bleeding includes bleeding that is prolonged (longer than a woman's normal menstrual period), too frequent (less than 21 days from the first day of one episode of bleeding to the first day of the next) or heavier than usual (or requiring more than a pad every hour during the heaviest time).

Diagnosis

A medical history and gynecologic examination are useful in identifying the cause of abnormal uterine bleeding. Endometrial biopsy is a way that a small amount of tissue can be removed from the uterine cavity to assist in making a diagnosis. Sometimes, hormone tests or an ultrasound examination is needed. Hysteroscopy, a procedure during which a small viewing instrument is placed into the uterine cavity in order to examine the cavity, also can be helpful.

Treatment

Abnormal bleeding may be treated with hormones such as oral contraceptive pills. Sometimes hysteroscopy is required to remove a polyp or small fibroid. Heavy bleeding often can be controlled by endometrial ablation, a procedure in which the uterine lining is removed or destroyed, resulting in decreased or absent bleeding. Some women choose hysterectomy, removal of the uterus, as the most definitive way of ending abnormal bleeding once and for all.

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