What is Irregular Menstrual Bleeding?
The volume and frequency of menstrual bleeding can be as capricious as it is varied. A dazzling array of technical definitions is used to describe the possible variations. Here are the main ones, and you may find yourself among the number.
- Polymenorrhea. This means that bleeding lasts for the normal number of days (four, five, or six or whatever is usual for a particular woman), but that it occurs more often. For instance, the total cycle is less than 24 days – it may mean a period comes on each 22 days or even less. It is caused by a variation in the regular rhythmic release of hormones that initiate the egg-release mechanism.
- Menorrhagia. Here the cycle is normal, but the duration and volume of bleeding is increased. Instead of lasting for the usual four to five days, it may persist for eight days or more. It usually means there is some hormonal imbalance present.
- Polymenorrhagia. In these cases, the bleeding is excessive, and the length of the cycle is reduced. Often this occurs when there is chronic inflammation occurring in the pelvic organs. But it is also often present in people suffering from emotional disorders, anxiety states and similar psychosomatic disorders.
- Metrorrhagia. This means bleeding is quite irregular, both in volume and duration. It is usually excessive, and is often associated with disease of the uterus.
- Dysfunctional uterine bleeding. When investigation fails to indicate any disease, this name tag is often applied. Frequently it is related to psychological or psychosomatic causes.
Irregular Menstrual Bleeding Causes
The Greeks held the view that the womb (hysteros in their language) controlled female emotions, and that any disorder of the uterus could produce hysterical and other abnormal mental states. Of’ course, this is not true, but rather the reverse is nearer the mark.
Emotional problems can often be transmitted through the higher cerebral centers to produce uterine abnormalities.
It is well documented that emotional upsets, tensions, anxieties, sexual frustrations, marital disharmony, work pressures, family disputes, submerged fears, can all lead to either complete failure of menstruation, or to uterine bleeding abnormalities.
These are capable of working on the part of the brain called the hypothalamus, and in turn the cyclical release of hormones that stimulates ovulation is prevented, or disturbed. In turn this leads to menstrual irregularities. However, there are many other causes of menstrual irregularities. Each part of’ the pelvic system can play a possible role. Disorders of the ovary itself can occur from tumors and cysts of this organ. Or the uterus itself’ may be at fault. Noncancerous growths called fibroids are notorious for producing heavy bleeding. But more important, cancer of the womb can also produce irregularities.
Heavy bleeding is common with the IUD (intra-uterine contraceptive device), although it is rarely used today. Pregnancy is the most common cause of abnormal bleeding, and its presence denotes a disturbance of the normal progress. It usually indicates an impending abortion (or miscarriage).
Irregular Menstrual Bleeding Treatment
It is essential that any sudden deviation from a person’s normal menstrual habits be investigated promptly by the doctor or gynecologist.
A full pelvic examination usually takes place at once after a thorough history has been taken.
It is imperative that the cause be discovered. Once this has occurred, then therapy can be instituted if this is warranted. In many cases, the cause is quite apparent.
Injuries (an increasingly common situation, especially with female participation in many erstwhile male sports, such as waterskiing) are usually obvious.
The bleeding of a pregnant woman is often (but not always) fairly self-evident. But often a diagnostic D and C (short for dilatation of the cervical canal and curettage of the walls of the uterus) is ordered promptly. This can be accompanied by a request for blood tests or pregnancy tests. Certain blood disorders may be present. Prolonged bleeding, even though it may not have been heavy but persistent, can produce anemia in women, and this is quite common. Tests will quickly indicate any of these abnormalities.
The operation is preceded by a general anesthetic. Then the gynecologist manually examines the patient’s pelvic organs to determine any obvious abnormalities.
When the patient is at complete rest and fully relaxed, a better examination may be carried out.
After this, the walls of the uterus are curetted or scraped clean. The “scrapings” are examined, and then sent to the pathologist for examination under the microscope.
This total exercise will often produce an answer it’ a physical cause exists. Blood tests may indicate a correctable abnormality. The physical examination may indicate the presence of cysts or solid tumors in the ovary or uterine wall. If a miscarriage is imminent, this may also be treated and the diagnostic routine then has become the therapy at the same time. Any abnormality in the uterine wall (such as meaty growths called polyps, a well-known troublemaker) will be swept away to be examined by the pathologist. Serious lesions such as cancer, if present, will show up in the microscopic study.
This is often carried out in conjunction with a laparoscopy. here, a thin, stainless steel tube with a light and magnifying lens at one end is inserted through a small incision (about 1 cm long) just below the navel, and directed downward to the pelvic cavity. At the free end, the gynecologist peers into a specially magnified eyepiece, and is able to obtain a complete bird’s eye visualization of the pelvic cavity and its contents. The doctor can therefore see if there is any obvious pathology present.
Today, a computer-chip camera may be attached to the tip of the laparoscope. A picture is transmitted electronically to a large VDU screen. This gives a full color, real-time enlarged picture of the parts under examination. The doctor watches the screen while manipulating the instruments. Whereas the D and C gives information of the internal part of the womb, this is an outside appraisal. What is more, it is often possible to actually treat any obvious disorder, such as piercing small cysts, cutting through adhesions, and caring for other anomalies that may be playing a part in the symptoms.
The laparoscope has revolutionized gynecological diagnosis and treatment and is now extensively used worldwide.
From this point on, treatment will depend on what eventuated at the operation and subsequent investigations. Whatever is amiss must then be corrected, if this has not automatically occurred with the D and C.
If no abnormality is detected, the patient may be subsequently placed on oral hormonal therapy.
Indeed, this has revolutionized the lot of the hapless bleeding woman. In old time (and that is not so very long ago), removal of the uterus was a common subsequent operation for cases in which persistent, heavy blood loss was taking place. There was no other simple remedy. But removal of the entire organ of course automatically solved the problem.
But today, with the universal availability of the contraceptive pill, which is really a combination of normally occurring estrogens and progestogens, a check to ovulation, and hence to uterine blood. This is of even greater importance in younger women, particularly those under the age of 35 years who may still wish to reproduce.
Once the uterus is removed, it is entirely impossible to reproduce ever again. However, in women over the age of 40, the full family complement has usually been acquired. These days, further pregnancies over this age are certainly discouraged, and the removal of the uterus for medical reasons is no great loss. Many women would prefer to take oral medication, rather than suffer the thoughts of a surgical operation, for it is a major one and there is always a slight risk factor. (However, crossing the busy highway in front of your home is probably a far riskier event than a straightforward hysterectomy carried out by experts today.)
Hysterectomy, surgical removal of the uterus, is probably the most common female operation next to the diagnostic D and C procedure. There is often criticism that too many are carried out, and that surgeons sometimes perform it unnecessarily and without giving other routines a fair trial.
In the long run, it is often up to the patient and doctor to fully discuss the alternatives. In any discussion of this nature, it is better to have a three-way talk, with the husband being present at the same time. He often likes to know the reasons for procedures of this magnitude (it is always a once-only event in any woman’s life. and is quite important to her and her partner).
Before the operation is the time to ask all the questions. It is not much use leaving these until afterwards. The surgeon usually will be happy to point out the pros and the cons for the recommended line of action. Take advantage of this, and listen and ask questions.
Abnormal or irregular uterine bleeding may indicate the presence of cancer, not only of the uterus itself, but possibly of other pelvic organs.
This is most likely in women who have passed the change of life, or the so-called menopause.
Post-menopausal bleeding is usually defined as bleeding that occurs six months or more after the menopause – that means when normal periods appear to have finished.
“One-fifth of these cases are due to malignancy,” the British Medical Journal recently stated. Under no circumstances should this be neglected. You must see the doctor promptly, even if you are scared stiff of what might be found. Only early diagnosis and prompt treatment offer hope of survival from cancers in this region. Do not put it off until tomorrow. Then it may be too late – forever. Whether the flow is frank blood, a watery fluid or a smelly, offensive material, the same rule applies. Get along to the doctor.
If you are in this age group and you are trying to retain your good looks and youthful appearance by taking hormonal tablets, irregular vaginal bleeding can occur. This is often of no serious consequence. But the same rule applies, for it is impossible to tell the difference until adequate investigation takes place. This usually means that a diagnostic D and C, preceded by a full pelvic examination, is essential.
But never put it off until tomorrow (or next week, next month or next year – unfortunately it is happening all the time). The life in peril could be yours, and you have total control over what you do.