Abnormal vaginal bleeding

Abnormal vaginal bleeding is defined as excessive or prolonged bleeding, or bleeding between menstrual periods. It is the most commonly reported menstrual problem and, in most cases, is related to changes in hormone levels which typically occur during the first year of menstruation and around menopause.

Types of bleeding

• Menorrhagia
  Heavy or prolonged menstrual bleeding. Most menstrual periods last 3 to 7 days, with an average blood loss of 60 mL. Women with menorrhagia however, may lose up to 90 mL of blood, and have periods that last more than 7 days. About 5% of women consult their doctor for this type of bleeding.
• Metrorrhagia
  Heavy bleeding that occurs between periods or bleeding that is almost permanent.
• Spotting
  Mild bleeding that occurs between periods.

Symptoms

Bleeding may be accompanied by fatigue and abdominal pain which is caused by uterine contractions. The level of pain is not related to the amount of blood loss.

It may be difficult to evaluate the amount of blood loss. The following may help determine whether you have heavy menstrual bleeding:

• Having to change sanitary pads or tampons every hour for several consecutive hours.
• Needing to use double sanitary protection.
• Needing to wake up to change sanitary protection during the night.

Anemia is the most common consequence of having a heavy menstrual period since these women are more prone to developing iron-deficiency. Heavy menstrual bleeding can also cause some women to faint.

A heavy menstrual flow can have a negative impact on overall quality of life, not to mention increase absenteeism from school or work.

Causes

The most common cause of menorrhagia is hormone imbalance. When ovulation is delayed, the endometrium continues to grow. The longer the endometrium is given to grow, the longer it needs to shed.

Other factors that may also contribute to irregular bleeding include:

• Benign tumours (fibroids or polyps): usually develop after the age of 35
• Hormone use (contraceptives, menopause or fertility therapy)
• Improper use of hormone medications: spotting is most often caused by improperly adjusted oral contraceptives
• Endometriosis

There are other causes but they are rare. They include: cervical, endometrial and ovarian cancer, pelvic inflammatory disease, certain medications (anticoagulants, chemotherapy), thyroid problems, lupus, blood coagulation disorders and ectopic pregnancy.

If bleeding occurs after years of regular menstrual periods, your doctor may conduct a thorough evaluation to determine the cause.

Treatment

For those who have been suffering from menorrhagia for a long time, treatment may consist of taking anti-inflammatories (Advil, Naproxen), oral contraceptives ("the pill") or using a Mirena IUD. If you recently developed menorrhagia, it is important to determine the cause. If you have spotting and the oral contraceptive you are taking is responsible, treatment should be evaluated by your doctor. Medications can be prescribed to stop the bleeding.

It goes without saying that if a patient is anemic, the situation should be corrected with iron supplements.

If you have any questions, do not hesitate to speak to your pharmacist.