Abnormal Uterine Bleeding
Abnormal uterine bleeding is a very common condition among women of any age. It can be caused by many factors. A wide range of treatments can be used, depending on the reason for the uterine bleeding and your personal needs and conditions.
The following types of uterine bleeding may be considered abnormal:
- bleeding after sex
- bleeding between periods or more frequent periods
- bleeding after menopause
- spotting or heavy periods or menstrual bleeding for more days than usual
What causes abnormal uterine bleeding?
Dr. Garofalo uses a classification system called PALM-COEIN for diagnosing abnormal uterine bleeding. PALM-COEIN stands for polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified. Following are descriptions of each classification.
- Polyp. Uterine (or endometrial) polyps are growths that are attached to the inner uterus wall and which extend into the uterine cavity. These polyps are usually noncancerous, although they can be cancerous or precancerous.
- Adenomyosis. This is a condition in which the inner uterus lining breaks through the muscle wall of the uterus. Adenomyosis can also cause cramps, bloating and heavy periods. It can be located throughout the entire uterus or localized in one spot.
- Leiomyoma. A leiomyoma is a noncancerous tumor, mostly consisting of smooth muscle cells. If leiomyoma causes bleeding or obstruction, it typically can be removed via a surgical procedure.
- Malignancy and hyperplasia. Similar to leiomyoma, hyperplasia is an increase in organic tissue that results from unusual cell growth that has occurred in response to a specific stimulus or condition, such as inflammation, damage or disease. Unlike leiomyoma, hyperplasia may be precancerous or cancerous.
- Coagulopathy. Also known as clotting disorders or bleeding disorders, coagulopathy is a condition in which the blood does not clot effectively. Coagulopathy can occur spontaneously or following an injury or a medical procedure.
- Ovulatory dysfunction. This condition occurs when ovulation (the release of an egg from the ovary) does not occur regularly. Anything that disrupts the hormonal regulation of the female cycle, including menopause, can result in ovulatory dysfunction.
- Endometrial. Endometrial conditions are those that arise from the endometrium (the lining of the uterus). They can include inflammation, infection or other conditions.
- Latrogenic. Iatrogenic conditions are those that occur as a result of medical treatment or advice.
- Not yet classified. This category is for conditions that are extremely rare or that have not yet been identified.
How is abnormal uterine bleeding diagnosed?
If you’re experiencing abnormal menstrual bleeding, Dr. Garofalo will review your medical history, stress level, eating and exercise habits, and use of medications and birth control. You can help prepare for your medical visit by keeping track of your menstrual cycle (dates, lengths and characteristics). Please download and complete the charts found below. Based on your symptoms, further diagnosis may require examination or tissue sample collection using ultrasound, X-ray, minimally invasive surgery or hysteroscopy (a procedure in which a thin, telescope-like device is inserted into the uterus through the vagina and cervix).
How is abnormal uterine bleeding treated?
Treatment depends on many factors, including the cause of the menstrual bleeding, your age, and whether or not you want to have children. Treatments may include one or more of the following:
- Medications. Options include hormones such as the Mirena IUD or birth control pills; nonsteroidal anti-inflammatory drugs such as ibuprofen; and Lysteda, a non-hormonal medication taken only as needed on days of heavy flow.
- Surgery. Possible surgical treatments include removal of fibroids or polyps (usually by hysteroscopy or minimally invasive surgery), myomectomy, endometrial ablation (which destroys the uterine lining) and hysterectomy.