Abnormal bleeding or bleeding between periods happens to most women at some point in their lives and is not always anything to worry about. In some cases, however, it persists and this is when it may be necessary to seek the advice of a gynecologist. Here I explain more about abnormal bleeding, its causes and the different treatment options available.
What is abnormal bleeding?
Bleeding that is irregular, that occurs between periods or after intercourse, bleeding that is very heavy or occurs after the menopause is considered abnormal.
Bleeding between periods
This is a common problem and is usually due to a hormone imbalance. It can also be caused by pelvic infections, or by polyps on the cervix or on the lining of the womb.
Bleeding after intercourse
If bleeding after intercourse happens many times, then it should be investigated. It can be caused by an ectropion (sometimes called an “erosion”) on the cervix, which is often present if you are taking the oral contraceptive pill. This can be seen at the time of a colposcopy. Other causes of bleeding after intercourse are polyps on the cervix or on the lining of the womb, and very rarely, cancer of the cervix. It’s really important to keep up to date with your cervical smear tests.
Bleeding after the menopause
Bleeding which occurs more than 12 months after you finish your periods, even if it is very light, requires investigation. The most common reason for this bleeding is atrophic vaginitis which means the skin of the vagina is dry and thin due to low oestrogen levels after the menopause. It can also be caused by polyps but it’s important to exclude any more serious causes for the bleeding, such as cancer of the womb.
Heavy periods can significantly interfere with your daily functioning. Bleeding is considered heavy if you are passing clots and needing to wear double protection with both a tampon and a pad. The most common cause of heavy bleeding is fibroids, which are benign growths comprised of muscle. Other caused are adenomyosis and hormonal imbalance.
What tests can be done
After a full history and clinical examination are performed, bloods tests can be done to check for anaemia, and hormone levels. An ultrasound scan of the pelvis will look at the lining of the womb, the ovaries, and can identify if there are any ovarian cysts causing the irregular bleeding. A hysteroscopy may be necessary to look at the lining of the womb, to take biopsies or remove polyps or fibroids.
When should I see a gynaecologist?
Most women are in tune with their bodies and know what is normal for them and what is not. When the nature or amount of bleeding is unusual for you, then it’s probably a good idea to have it checked out.