IRREGULAR MENSTRUAL PERIODS

Abnormal uterine bleeding can either be:

• Anovulatory, which occurs when periods are irregular with absent, minimal or excessive bleeding. Under this type are the women who never had their menses and those who have infrequent periods.
• Ovulatory, this occurs in periods that occur regularly but have excessive bleeding or lasts longer than 7 days.

Symptoms of abnormal uterine bleeding include:

• Vaginal bleeding that occurs more often than every 21 days or farther apart than 35 days (a normal teen menstrual cycle can last up to 45 days).
• Vaginal bleeding that lasts longer than 7 days (normally lasts 4 to 6 days).
• Blood loss of more than 80 mL (3 fl oz) each menstrual cycle [normally about 30 mL (1 fl oz)]. If you are passing blood clots and soaking through your usual pads or tampons each hour for 2 or more hours, your bleeding is considered severe.

Your doctor looks for a number of possible causes of your bleeding.

First tests

First, your doctor will:

• Review your history of symptoms and menstrual periods. (If possible, bring with you a record of the days you had your period, how heavy or light the flow was, and how you felt each day.)
• Conduct a routine pelvic exam.
• Find out whether you are ovulating regularly.

Other tests

If your symptoms are severe, your doctor suspects a serious medical problem, or you are considering a certain treatment, you may also have one or more other tests, such as:

• Blood tests, which may include:
  • Pregnancy test (human chorionic gonadotropin, or hCG).
  • Complete blood count (CBC), to check for signs of disease, infection, and anemia.
  • Thyroid-stimulating hormone (TSH) to check for a thyroid gland problem, which can cause menstrual irregularity.
  • Serum prolactin level, to check for a pituitary gland problem, which can interfere with or stop the menstrual cycle.
  • Serum ferritin, to check for anemia, a symptom of heavy blood loss.
• Pap smear and cultures to check for infection or abnormal cervical cells.
• Urine test to screen for infection, disease, and other signs of poor health.
• Transvaginal pelvic ultrasound, to check for any abnormalities in the pelvic area. After the pelvic exam, a transvaginal ultrasound is often the next step in diagnosing a vaginal bleeding problem. If a pelvic mass is found, ultrasound results are useful for making further testing and treatment decisions.
• Sonohysterogram, which uses ultrasound to monitor the movement of a salt solution (saline), which is injected into the uterus. This test may be done to look for uterine polyps or fibroids.
• Endometrial biopsy, usually for women older than 35 or who are postmenopausal, to learn whether the lining of the uterus (endometrium) is healthy and functioning normally.
• Hysteroscopy, if no cause is apparent but a problem condition is suspected; to check for and treat a suspected condition, such as uterine fibroids; or if bleeding continues despite treatment.

RECOMMENDED MEDICATIONS

Hormonal medications are often used to control abnormal uterine bleeding.  The type of hormone you will take depend on whether you want to get pregnant as well as your age.

Medicine choices

There are several hormone therapies for managing abnormal uterine bleeding. These treatments help reduce bleeding and regulate the menstrual cycle:

• Birth control pills (synthetic estrogen and progesterone). This can reduce the amount of heavy menstrual bleeding by about half. This can also make the cycle more regular.
• Progestin pills (synthetic progesterone). In some women, progestins can control endometrial growth and bleeding. You usually take progestins 10 to 12 days every month.
• The levonorgestrel intrauterine device (IUD). A doctor inserts this birth control device into your uterus through your vagina. It stays in your body for up to 5 years and releases levonorgestrel, a form of progesterone, into the uterus.
• Estrogen. In some severe or urgent cases, estrogen may be used to reduce bleeding.
• Hormone suppressors such as gonadotropin-releasing hormone analogues (GnRH-As). GnRH-As are rarely used. These drugs reduce estrogen production, making your body think it is in menopause. This reduces or stops menstrual periods for as long as you take the medicine. Side effects with GnRH-As are common.
• Nonsteroidal antiinflammatory drugs (NSAIDs) decreases bleeding and is used together with oral contraceptives.

A medicine called tranexamic acid (such as Lysteda) is sometimes used for women who have bleeding that is heavier than normal. This medicine is not a hormone. It prevents bleeding by helping blood to clot. Talk to your doctor to find out if this option is right for you.