Thursday, June 30, 2011

Abnormal Uterine Bleeding

What causes abnormal bleeding?  Abnormal bleeding from the uterus (anything not consistent with a regular menstrual cycle for a female) can be caused be a wide variety of things such as medications( contraceptives, blood thinners, steroids, antipsychotics, chemo, dilantin, some antibiotics, others), or benign growths such as polyps, thick uterine lining, fibroids; infections of the uterus; issues of the cervix such as polyps or endometriosis; cancer of the uterus or cervix; sexually transmitted diseases. There are many other causes of abnormal bleeding—it just depends on where the location is in the genital tract.
Age, sexual activity, pregnancy possibilities, ovulation, eating disorder symptoms, and if this is like a normal period are all other factors in determining cause.
For example, causes of abnormal bleeding in women between age 40 and menopause are usually due to growths, either benign or malignant.
For women between teenage and about 20, the causes are broken down based upon whether or not one ovulates or not. If you ovulate and bleed abnormally, the bleeding is usually cyclic only heavy or prolonged.  The cause is usually anatomic or physical such as a polyp, fibroid, endometriosis, cancer, or a foreign body. Hormone levels are normal in this circumstance.
What about bleeding outside of regular menstrual cycle?  Anovulatory means bleeding that occurs outside of ovulation, hence it is unpredictable. It is the most common cause of abnormal uterine bleeding. The cycle of when sex hormones are produced is off so bleeding is irregular (bleeding is a function of hormone interaction). The most common cause of this scenario is too much estrogen causing the lining of the uterus to become too thick, outgrowing its blood supply and eventually dying off. This causes irregular, prolonged and heavy bleeding.
So, what can cause a woman to stop ovulating? There are many possibilities such as: thyroid disorders, polycystic ovary syndrome, liver or kidney disease, endocrine disorders such as Cushing’s disease, eating disorders, intense exercise, stress, pituitary growths, tumors of the pituitary or brain and other things. The most common of these are stress,  polycystic ovary syndrome (PCOS)—comprised of obesity, abnormal hair growth, acne, and irregular periods., and abnormal exercise (too much of a good thing!).
For a teenager, ovulation is not always consistent. So, there may be episodes of no periods interspersed with times of heavy bleeding. This is because the hormonal axis in the body is still maturing. As always, make sure the person is not pregnant!
At the end of the day a biopsy of the lining of the uterus may be needed to help discern the cause of the bleeding. Most importantly, it is the way to rule out cancer.
What is the treatment?  Treatment is diverse from correcting the underlying problem to attempting to regulate the hormones with birth control pills to surgical intervention. As one can see, a health care professional is needed for cases of abnormal bleeding.


Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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