Abnormal Vaginal Bleeding
Vaginal bleeding can occur through different factors, with some causes easily treated. However, some may need further surgical assistance.
Unusually substantial or prolonged bleeding is not to be confused with heavy menstrual bleeding, common in premenopausal women. These heavy periods are most likely caused by hormone imbalances which produce menstrual cycles lacking ovulation. Hormone changes are most common in adolescents and women in the 40-50s as they approach menopause.
If you are experiencing heavy periods, you may also be experiencing some of the following symptoms:
- Anemia – fatigue, shortness of breath
- Menstrual bleeding for over a week
- Saturation of one or several pads/tampons within an hour consecutively
- Preventing daily activities due to substantial menstrual flow
- Producing heavy periods with blood clots for several days
- Waking during the night to change sanitary protection
If you are experiencing any of these symptoms, please make an appointment to see your doctor.
While heavy periods are most likely caused by hormone imbalances, there are a number of other possible causes:
- Hormone imbalance
- Ovary malfunction
- Uterine fibroids
- Intrauterine device
- Pregnancy problems
- Inherited disorders of bleeding
- Particular medications
- Pelvic inflammatory disease
- Thyroid malfunction
- Liver or kidney disease
Methods such as a blood test, ultrasound or endometrial biopsy will be used to investigate heavy menstrual bleeding. Once investigated, the following treatments are available:
- Anti-Inflammatory Medication
- Oral contraceptive pill (OCP)
- Tranexamic acid
- Surgical hysteroscopy
- Other alternative treatments
Abnormal Pap Smear
A cervical screening test is commonly called a Pap smear. This involves a small spatula and brush that collect cells from the cervix. It screens for the Human Papilloma Virus (HPV), precancerous and cancerous cells. When any of these abnormal cells are detected, a follow-up including a colposcopic exam is required.
Polycystic Ovarian Syndrome (PCOS)
Polycystic Ovarian Syndrome is a common hormonal disorder among women of reproductive age. The symptoms are irregular or prolonged periods, excessive hair growth all over, acne, increased weight, male-pattern baldness and infertility.
Bleeding After Intercourse (Post-Coital Bleeding)
Post-coital bleeding from the vagina and other urinary parts after sex can occur even when you are not menstruating. This symptom is more concerning with older or post-menopausal women.
Possible causes of bleeding after intercourse include:
- Genital sores (herpes, syphilis)
- Cervicitis (chlamydia, gonorrhoea)
- Cervical ectropion/eversion, and polyps
- Cervical cancer
- Damage to the uterine lining
- Lack of lubrication during intercourse
- Menstrual period
- Sexual abuse
- Substantial friction during intercourse or trauma
- Vaginal atrophy, and dryness
If you are experiencing regular episodes of post-coital bleeding, you may need an examination and tests to determine the cause.
Polyps have the potential to form in any organ with blood vessels as a result of abnormal tissue growth. Most commonly they do not need treatment unless they become painful or being to bleed. Polyps are typically benign; however, they can become cancerous (malignant) due to the abnormal tissue growth.
The two main types of polyps are:
- Uterine Polyps – They are formed by the overgrowth of endometrial tissue and can range in size. Like most polyps, uterine polyps are usually benign, but they can cause issues with menstruation or fertility.
- Cervical Polyps – Are commonly cherry-red to reddish-purple or greyish-white and can vary in size. There are two types of cervical polyps:
- Ectocervical polyps develop on the outer surface of the cervix.
- Endocervical polyps are found in the cervical glands inside the cervical canal.
Many polyps are incidental and do not usually cause symptoms, however when this does occur symptoms include:
- Irregular menstrual periods
- Heavy menstruation
- Light bleeding between menstrual periods
- Abnormal vaginal bleeding and pain, especially after intercourse.
- Vaginal spotting or bleeding after menopause
- Abnormal discharge
Uterine and cervical polyps can be identified through the use of multiple different tests:
- Routine pelvic exams
- Cervical screening test
- Endometrial biopsy
Ovarian cysts are fluid-filled sacks either within or on the surface of an ovary. They mostly form during ovulation when an egg is released from the ovary. They are very common in premenopausal women and usually harmless; often causing little to no discomfort before disappearing on their own. Approximately 8% of premenopausal women develop large cysts which require treatment.
Most ovarian cysts are so small that they cause no symptoms. Those that grow larger may cause:
- Pain in the lower abdomen on the side of the cyst. The pain may come and go and may be either sharp or dull.
- Abdominal pressure
Other less common symptoms include:
- More frequent need to urinate
- Problems emptying the bladder or bowel completely
- Pelvic pain
- Aching in the lower back and thighs
- Breast tenderness
- Pain during sex
- Pain during your period
- Unusual vaginal bleeding
- Unexplained weight gain
Occasional complications which arise from ovarian cysts include:
- Rupture: If a cyst bursts it can lead to intense pain and internal bleeding
- Ovarian torsion: A large cyst may cause an ovary to move abnormally or twist producing severe pain.
- Ovarian cancer: Cysts in postmenopausal women have a chance of being malignant
Ovarian cysts cause swelling which can be identified by doctors through a pelvic exam. Once a cyst has been identified doctors will either monitor the cyst or perform further tests to identify the best treatment. Tests may include an ultrasound, a pregnancy test, or a blood test.
Most small ovarian cysts will disappear on their own. As such, the treatment is often to monitor the cyst and use over the counter pain medication to manage pain.
A cyst may require surgical removal in cases where it:
- Is large and/or growing
- Doesn’t look like a functional cyst
- Persists through two or three menstrual cycles
- Causes pain or other symptoms
- Some cysts can be removed from the ovary through ovarian cystectomy. In other cases, the entire ovary may be removed in a procedure known as oophorectomy.
If you are pregnant and experiencing abnormal vaginal bleeding, it is possible you are experiencing a miscarriage.