It is not uncommon for women to experience some form of abnormal uterine bleeding at least once during their reproductive years. Abnormal bleeding can be defined when:
- Bleeding occurs between periods
- Bleeding occurs following sex
- Spotting occurs at any time during the menstrual cycle
- Bleeding is heavier than normal or lasts for more days than usual (“menorrhagia”)
It is normal for many women to experience heavy bleeding periods during the first few years of menstruation, as a teenager and then again just prior to menopause.
There are various problems that can cause menstrual heavy bleeding, most of which are benign and treatable. Any abnormal bleeding should be evaluated promptly to rule out cancer or pre cancer and give you peace of mind. Cancer increases in women post menopause to approximately 10%.
- Hormonal imbalance. If a hormonal imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding.
- Dysfunction of the ovaries. If ovulation does not occur in a menstrual cycle (anovulation), progesterone is not produced. This causes hormonal imbalance and may result in menorrhagia.
- Uterine fibroids. Uterine fibroids are benign tumors that may cause heavier than normal or prolonged menstruation.
- Polyps. Polyps are small, usually benign growths on the lining of the uterine wall (uterine polyps) or usually benign growths on the cervix (cervical polyps).
- Adenomyosis. This condition occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding periods and painful menses.
- Intrauterine device (IUD).
- Pregnancy complications. A single, heavy, late period may be due to a miscarriage.
- Cancer. Rarely, uterine cancer, ovarian cancer and cervical cancer can cause excessive menstrual bleeding.
- Inherited bleeding disorders. Some blood coagulation disorders — such as von Willebrand’s disease, may cause irregular, prolonged or heavy bleeding periods.
- Medications. Certain drugs, including anti-inflammatory medications and anticoagulants, can contribute to heavy or prolonged menstrual bleeding.
- Other medical conditions. A number of other medical conditions, including pelvic inflammatory disease (PID), thyroid problems, endometriosis symptoms and liver or kidney disease, may be associated with menorrhagia.
Diagnosis may involve ultrasound, saline infusion sonohysterography, endometrial biopsy or colposcopy. (See: In-office Procedures.)
Drug therapy for menorrhagia may include:
- Iron supplements.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve), help reduce menstrual blood loss.
- Oral contraceptives.
- Oral progesterone.
- The hormonal IUD (Mirena). This type of intrauterine device releases a type of progestin called levonorgestrel.
You may need surgical treatment if drug therapy is unsuccessful. Treatment options include:
- Dilation and curettage (D&C) involves removal of tissue from the lining of your uterus to reduce menstrual bleeding.
- Hysteroscopy with polypectomy or myomectomy involves surgical removal of a polyp or fibroid that may be causing excessive menstrual bleeding.
- Endometrial ablation permanently destroys the entire lining of the uterus (endometrium). After endometrial ablation, most women have little or no menstrual flow. (See video on Novasure in our video gallery)
- Total hysterectomy. Surgical removal of the uterus and cervix. (See video on DaVinci Robotic Hysterectomy in our video gallery.)
To learn more about our abnormal bleeding services or to schedule an appointment, please call our main office at (404) 255-3633. You can also use our online Request an Appointment form. Our abnormal bleeding patients come to us from the area of Buckhead in Atlanta, Forsyth, Cumming, North Atlanta, Sandy Springs, Alpharetta, Dunwoody and Roswell in Fulton County, GA.