Treating Abnormal Bleeding - Q&A

When is bleeding considered “abnormal”?

The answer depends upon the type of bleeding, as well as the age and the reproductive status of the woman. An adolescent or mature woman’s irregular or heavy vaginal bleeding is sometimes considered abnormal, but any vaginal bleeding in a woman past menopause is abnormal.

What should I do if I experience abnormal bleeding?

It’s important for a mature or postmenopausal woman to report any unusual bleeding to her doctor, as should any woman who experiences bleeding after sexual intercourse.

Bleeding may be the only evident symptom of cysts, pelvic inflammatory disease, sexually transmitted disease, and several types of cancer; your doctor may order tests to rule out these serious conditions.

The type of treatment depends upon the cause of the bleeding. Treatments range from observation alone to hormone therapy and a variety of medications. In some cases, surgical intervention, such as endometrial ablation, may be necessary.

What can be done about heavy menstrual periods?

Approximately one in five women experience menorrhagia, very heavy or long menstrual periods (repeatedly filling a maxipad or tampon within an hour). Women with menorrhagia may become anemic and experience significant fatigue and should have regular blood tests to ensure that the level of red blood cells (hematocrit) stays within a safe range.

There are several approaches to managing heavy menstrual periods. Your doctor can help you to prevent or treat the resulting anemia by prescribing iron supplements. As with other abnormal bleeding, actually lessening the heaviness or shortening the length of your periods may require treatment with hormones or surgical intervention.

The endometrium, the lining of the uterus, produces the bleeding. Your doctor may recommend endometrial ablation, which permanently removes the lining of the uterus and is suitable only for women who no longer want to have children. Another procedure, D&C (dilation and curettage) is where the endometrium is scraped.

Recommended references:

The New Harvard Guide to Women’s Health, by Karen J. Carlson, M.D., Stephanie A. Eisenstat, M.D., and Terra Ziporyn, Ph.D. Harvard University Press (2004).

A Woman’s Guide to Menopause & Perimenopause, by Mary Jane Minkin, M.D., and Carol V. Wright, Ph.D. Yale University Press (2005).