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Notes on Women's Health
Notes on Women's Health

Abnormal Vaginal Bleeding During Your Reproductive Years: What You Need to Know

Woman experiencing abnormal bleeding and crampsOne of the most common reasons that patients come to our medical office in Norwalk is because they have questions or concerns related to abnormal vaginal bleeding. This isn’t really a surprise: About a third of all outpatient visits to gynecologists in the United States are for heavy period bleeding, an unusually long period, or unusual bleeding between periods. But even though it’s common, irregular bleeding can be a major cause for concern, especially during pregnancy. And despite its possible effects on a woman’s lifestyle and health, irregular bleeding can be something that patients overlook, especially if the increase in bleeding has occurred gradually.

What is abnormal uterine bleeding?

For women during their reproductive years, a typical menstrual flow “period” occurs for about five days. The menstrual cycle usually lasts between 21 days and 35 days. Your bleeding may be abnormal if it doesn’t follow these patterns or if the amount of bleeding is unusually high. If you’re wondering how much bleeding qualifies as “abnormal,” remember that you’re the best judge of what is normal for your body. It may be useful to know that irregular bleeding occurs most commonly at the beginning and end of the reproductive years: About 20% of cases occur in adolescent girls and more than 50% occur in women over the age of 45, but it can happen at any point in a woman’s life. If you’re not sure if what you’re experiencing is abnormal, it’s a good idea to check with your doctor.

What causes irregular bleeding?

Irregular bleeding is a common issue but it’s also complicated, since it can be caused by so many different factors. Back in 2011, the International Federation of Gynecology and Obstetrics came up with an acronym that covers most of the possible reasons why a woman might experience heavy period flow and other unusual bleeding during her reproductive years. This acronym is PALM-COEIN, and it’s the classification system that we use in our practice. Each letter stands for a different diagnosis. The PALM letters cover “structural” causes such as polyps (small abnormal growths) and fibroid tumors, while the COEIN letters include “nonstructural” causes such as clotting disorders, ovulation problems and endometriosis (when the tissue that usually grows inside the uterus grows outside the uterus). Bleeding levels can be affected by many other factors, including stress, pregnancy, infections, irritation, blood and thyroid disorders, and hormone-based birth control.

When to seek medical attention

If you’re bleeding more (or less) than usual, or if the frequency of your bleeding changes noticeably, then you should check in with your doctor. If your bleeding is accompanied by other symptoms such as lightheadedness, severe abdominal pain or fevers, you should be evaluated as soon as possible. Otherwise, an office visit to a gynecologist is usually appropriate.

What to tell your doctor

You’ll be able to help your doctor determine the cause of irregular bleeding if you know the answers to a few questions. Your health care professional will likely ask you about the following:

  • Details about your most recent episode of vaginal bleeding
  • Your most recent normal menstrual cycle
  • Any previous episodes of abnormal bleeding, including a calendar record or an assessment chart, if you have one
  • If you may be pregnant
  • Your previous pregnancies and their outcomes
  • Your recent sexual activity
  • Your past or current use of any form of birth control
  • Any medications, supplements or illicit drugs you’re taking
  • Any personal or family history of bleeding disorders
  • Any recent surgeries or gynecological procedures

Possible tests and examinations

After asking these questions, your doctor will probably perform a complete physical examination, including a thorough pelvic exam to look and feel for any abnormalities. This may involve use of an ultrasound imaging test. Your doctor may also take fluid or tissue samples to test for pregnancy, bleeding disorders, thyroid problems, sexually transmitted diseases, cancer or other possible conditions.

Treatments for abnormal uterine bleeding

Just as there are many potential causes of irregular bleeding, there are many possible treatments, from medications to advanced surgery. If your bleeding is related to hormonal irregularities, treatments may involve the use of prescription hormones such as birth control pills to make adjustments to your menstrual cycle. If other causes are found, treatment is generally directed toward the underlying cause. Your healthcare professional should be able to go through all your options with you to help you understand your condition, its causes, and your options for treatment.

Additional information

If you have any questions about abnormal uterine bleeding, feel free to contact us for more information and to discuss your particular situation. Other information resources can be found below.

American Congress of Obstetricians and Gynecologists: abnormal uterine bleeding FAQs

National Heart, Lung, and Blood Institute: blood disorders

About the practice

Dr. John Garofalo, M.D., is a gynecologist located in Fairfield County, Connecticut. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

Laury Berkwitt, APRN, is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for more than 10 years, caring for women of all ages.

For more information, go to www.garofaloobgyn.com. John Garofalo, MD, and Laury Berkwitt, APRN, can be reached for personal consultations by calling 203.803.1098.