Abnormal Menstruation

Abnormal Uterine Bleeding

What is abnormal uterine bleeding?

Abnormal uterine bleeding is any bleeding from the uterus (through your vagina) other than your normal monthly period. Having extremely heavy bleeding during your period can also be considered abnormal uterine bleeding. Very heavy bleeding during a period and/or bleeding that lasts more than 7 days is called menorrhagia (say: “men-oh-raj-ee-ah”). Women who have menorrhagia may, for example, bleed enough to soak through 1 or more tampons or sanitary pads every hour.

What causes abnormal uterine bleeding?

Many different things can cause abnormal uterine bleeding. Pregnancy is a common cause. Polyps or fibroids (small and large growths) in the uterus can also cause bleeding. Rarely, a thyroid problem, infection of the cervix or cancer of the uterus can cause abnormal uterine bleeding.
In most women, abnormal uterine bleeding is caused by a hormone imbalance. When hormones are the problem, doctors call the problem dysfunctional uterine bleeding, or DUB. Abnormal bleeding caused by hormone imbalance is more common in teenagers or in women who are approaching menopause.
These are just a few of the problems that can cause abnormal uterine bleeding. These problems can occur at any age, but the likely cause of abnormal uterine bleeding usually depends on your age.

Women in their teens, 20s and 30s

A common cause of abnormal bleeding in young women and teenagers is pregnancy. Many women have abnormal bleeding in the first few months of a normal pregnancy. Some birth control pills or the intrauterine device can also cause abnormal bleeding.
Some young women who have abnormal uterine bleeding do not release an egg from their ovaries (called ovulation) during their menstrual cycle. This is common for teenagers who have just started getting their periods. This causes a hormone imbalance where the estrogen in your body makes the lining of your uterus (called the endometrium) grow until it gets too thick. When your body gets rid of this lining during your period, the bleeding will be very heavy. A hormone imbalance may also cause your body not to know when to shed the lining. This can cause irregular bleeding (“spotting”) between your periods.

Women in their 40s and early 50s

In the years before menopause and when menopause begins, women have months when they don't ovulate. This can cause abnormal uterine bleeding, including heavy periods and lighter, irregular bleeding.
Thickening of the lining of the uterus is another cause of bleeding in women in their 40s and 50s. This thickening can be a warning of uterine cancer. If you have abnormal uterine bleeding and you’re in this age group, you need to tell your doctor about it. It may be a normal part of getting older, but it's important to make sure uterine cancer isn't the cause.

Women after menopause

Hormone replacement therapy is a common cause of uterine bleeding after menopause. Other causes include endometrial and uterine cancer. These cancers are more common in older women than in younger women. But cancer is not always the cause of abnormal uterine bleeding. Many other problems can cause bleeding after menopause. For this reason, it’s important to talk to your doctor if you have any bleeding after menopause.

Pelvic Organ Prolapse Treatments

Pelvic organ prolapse (POP) is a relatively common occurrence for women older than 50. In fact, it is estimated that as many as 50 percent of women in this age group have some degree of POP. Treatment for pelvic organ prolapse can be as simple as dietary changes or daily exercises, or it can include surgical procedures.

One of the most recent developments of surgical treatment of POP has included the use of transvaginal mesh. Even though transvaginal mesh has been declared "high risk" by the FDA, it continues to be used in routine gynecological practices around the nation. It is important that women educate themselves on their treatment options to avoid unnecessary health risks.

What is Pelvic Organ Prolapse?

The organs in a woman's pelvic region — the uterus, bladder and rectum — are connected by muscles and ligaments that hold them in place. These tissues become compromised, usually by pregnancy and childbirth. By the time a woman reaches menopausal age and beyond, the connective tissues can become so weakened that certain organs can shift, or drop.

In some cases, this shifting is so mild that the woman is unaware of it and it is diagnosed by her gynecologist in a routine pelvic exam. For other women, these organs can shift and drop so much that they begin to collapse into the vaginal canal. This can be uncomfortable and/or painful. In worst-case scenarios, a woman's ability to urinate or defecate can become severely compromised.

Treatment for Pelvic Organ Prolapse

There are a variety of treatments available for POP. It is important that women realize that treatment is often unnecessary. If a doctor diagnoses POP in an asymptomatic woman, the condition can continue to be monitored without any treatment as long as there are no negative side effects.

Non-Surgical Treatments

Dietary and Lifestyle Changes - Decreasing caffeinated beverages can reduce the need to urinate. Increasing fiber intake can prevent constipation. As obesity is linked to POP, maintaining a healthy diet and regular exercise routine can also help. A healthy lifestyle can reduce mild symptoms of POP.

Physical Therapy - Kegel exercises should be done regularly to strengthen the pelvic floor. Sometimes doctors will use electrical stimulation to contract the muscles in the vagina and pelvic floor to strengthen the connective tissue and reverse the condition.

Vaginal Pessary - A pessary is used like a diaphragm. It is carefully fitted into the vagina and provides the support necessary to keep organs from dropping further.

Surgical Treatments

Hysterectomy - If the prolapse is concentrated in the uterus, and a woman is through her childbearing years, a hysterectomy can often remedy the symptoms.

Reconstructing Vaginal and Pelvic Organ Support - There are several surgeries that can be used to rebuild the support of the vagina and connective tissues. Sometimes this surgical support is constructed using grafting tissues. A synthetic transvaginal mesh is an alternative to natural grafting tissues in these types of surgeries. Women need be exceedingly cautious before allowing transvaginal mesh to be used to correct POP. There have been serious complications linked to the use of transvaginal mesh.  There are even patients who have started to file a transvaginal mesh lawsuit against the mesh manufacturers because of such complications.

Women should educate themselves on the various treatments for POP and make sure to talk openly with their doctor regarding whether treatment is even necessary, as well as ensuring the treatment that is used will be the safest choice for their situation.