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ABNORMAL VAGINAL BLEEDING
If you are experiencing abnormal bleeding from the vagina, it is important to find out why. An expert ultrasound scan is the most important investigation.
A careful examination will detect many causes of abnormal vaginal bleeding
How do you define abnormal bleeding?
Abnormal vaginal bleeding can be:
Frequently asked questions about abnormal bleeding
What is postmenopausal bleeding?
Postmenopausal bleeding refers to any bleeding after the menopause. Even a brownish discharge, that occurs after the menopause.
The usual definition is that it occurs 12 months or more after the last period.
How common is postmenopausal bleeding?
Postmenopausal bleeding is very common and is not usually serious. In a small number of women, it will be the first sign of a cancer. We would always recommend investigation.
How do I know whether the bleeding is just a late period or abnormal bleeding?
Bleeding after the menopause can seem like a period. We should investigate postmenopausal bleeding if you have not had a period for 12 months. We arrange initial investigations as an outpatient in a single visit.
What are the common causes of postmenopausal bleeding?
The skin of the genital tract is very responsive to ovarian hormones. The most important hormone is estrogen.
After the menopause, estrogen levels are very much reduced. This causes the skin of the whole genital tract to thin.
This affects the vulva, the vagina, the skin of the cervix and also the endometrium lining the uterus.
The skin in each of these areas is more easily damaged and non specific inflammation may also occur. Usually we find no specific site of bleeding.
How is postmenopausal bleeding investigated?
Investigation involves checking for the possible cancers. We use ultrasound scan to examine the ovaries and also the thickness of the lining of the uterus. We examine the vagina and cervix with a pelvic examination. We sometimes need to take a sample from the lining of the uterus.
What causes bleeding between periods?
Bleeding between periods (intermenstrual bleeding) is often caused by a slight hormone imbalance.
Missed tablets of oral contraception is a very common cause.
Alteration in the normal pattern of activity can cause bleeding between periods.
How common is bleeding between periods?
Many women experience bleeding between periods. Sometimes it is only spotting between periods.
Mid cycle spotting is often associated with ovulation and may cause pain. Bleeding after period is also very common and is usually not of any significance.
Does bleeding between periods need to be investigated?
If the bleeding between periods has only occurred once, investigation is not required. If it is repeated and particularly if it occurs at different times in the cycle, it is more important to investigate it.
What causes bleeding after sex?
Bleeding after sex (post coital bleeding) is very common. It is usually caused by bleeding from inside the uterus. This may be because of a slight hormone imbalance. Bleeding can occur from the cervix. This is more common if there is inflammation of the cervix.
Should bleeding after sex be investigated?
It is important to investigate bleeding after sex. This can be a symptom of cervical cancer.
We examine the cervix carefully. A colposcope magnifies what we see and is helpful. We usually take a cervical smear.
What is a heavy period?
A heavy period is a period where the blood loss is higher than the average. Most women lose about 30 to 40 ml of blood with each period.
Passing blood clots is a sign that the period is heavy, as is flooding or bleeding through clothes. Bleeding more than 60 ml to 80 ml is a heavy period.
Needing to use both sanitary towels and tampons is also a sign that the period is very heavy.
What causes heavy periods?
Most heavy periods have no identifiable cause.
This usually occurs in women between 40 and 50 years of age. It may occur in menstrual cycles in which ovulation has not occurred. Other causes include endometriosis, fibroids, polyps and very occasionally cancer of the uterus.
How are heavy periods investigated?
The investigation of heavy periods involves a careful history. We perform a clinical examination involving a pelvic examination. Blood tests check many causes for heavy periods.
An expert ultrasound scan of the pelvis completes the basic investigations.
What are irregular periods?
An irregular period is when the timing between periods varies from month to month. This is often associated with heavy periods. It is also seem in women with polycystic ovarian syndrome.