Abnormal Menstrual Bleeding, Heavy Bleeding

What is Normal Bleeding?

In order to more accurately define abnormal bleeding its best to first describe what is normal. The onset of the menstrual period occurs between the ages of nine and seventeen with the average age being thirteen. Adolescents tend to have periods that can vary from twenty to forty-five days for the first few years and then establish more regularity over the subsequent years. Most adult women will have a menstrual cycle, measured from the first day of any bleeding to the next episode of bleeding, about every twenty-one to thirty-five days. Although twenty eight days is considered the “norm” for the lenght of the cycle, only 15 percent of women actually have cycles of that length. Bleeding usually lasts four to six days, with some women bleeding a few days longer or shorter.

When is Vaginal Bleeding Abnormal?

Abnormal vaginal bleeding is said to occur if you have a period more often than every twenty-one days, less often than every thirty five days, or if you have bleeding or spotting between periods. Bleeding more than 30 to 40 milliliters per month is abnormal and, if persistent, will lead to anemia. Very heavy bleeding, saturating a pad or tampon every hour or two for more than a few hours is also abnormal.

Simply put, you are experiencing abnormal menstrual bleeding:

  • When you are not expecting your menstrual period
  • When your menstrual flow is lighter or heavier than what is normal for you
  • At a time in life when it is not expected such as before age 10, when you are pregnant, or after menopause

Causes of Abnormal Bleeding:

There are a number of causes for abnormal bleeding, the good news is that most of them are benign and easily treatable.

  • Stress: the secretion of chemicals in the brain and the release of hormones that regulate the menstrual cycle in the pituitary gland can be highly susceptible to stress. The sensitivity of the brain to stress is evidenced by the fact that about 20 percent of all female collage freshmen will experience abnormal periods during the first year of academic and social pressure.
  • Adolescence: the adolescent years are often accompanied with a lack of maturation in brain-ovaries connection which can lead to a high degree of irregularity. It takes a few years for this connection to become mature and balanced. The common traditional treatment plan for younger women with physiological menstrual cycle abnormalities (lack of maturation) is the “birth control pill”. Naturopathic medicine can offer alternative treatments for patients who are looking for safe, holistic and natural treatments to help their bodies regulate and normalize their hormonal imbalance.
  • Perimenopause: if you are age 40 or older, abnormal vaginal bleeding may mean that you are entering perimenopause. In perimenopause, women do not ovulate as frequently, resulting in an unopposed estrogen effect on the uterus in the absence of the balancing function of progesterone resulting in irregular menstrual bleeding.
  • Daily regimen of estrogen and progesterone normally prescribed for menopausal women: during the first few months (no more than six months) of this continuous regimen, as the uterus adjusts to the hormones, bleeding may be irregular and unpredictable. It is usually not heavy or persistent. However, if heavy or persistent bleeding is in fact present, the cause needs to be investigated. After a few months on estrogen and progesterone, most women will have no bleeding at all for as long as they are on the hormones. If bleeding occurs after a few months, it should be reported to the healthcare professional regardless of whether it is light or heavy.
  • Pregnancy: Because bleeding can indicate a problem with pregnancy, possible pregnancy should always be considered in a woman of childbearing age. Heavy vaginal bleeding or bleeding that occurs before 12 weeks of pregnancy may indicate a serious problem, including an ectopic pregnancy or miscarriage. Bleeding that occurs after 12 weeks also may indicate a serious problem, such as placenta previa. Placenta previa is a condition that may occur during pregnancy when the placenta implants in the lower part of the uterus and is close to or covering the cervical opening to the vagina (birth canal).
  • Ovulation: can cause mid-cycle spotting due to the rupture of follicles (shell surrounding the egg).
  • Weight gain or weight loss: If you miss a period while dieting or after gaining a considerable amount of weight you should see you doctor to make sure no other problems exist.
  • Medication: most medications used to treat medical illnesses do not interfere with the menstrual function. However, sleeping pills, tranquilizers, and antidepressants all can change menstrual cycle by affecting the area of the brain that regulates the production of hormones.
  • Birth control pills: You may have minor bleeding between periods during the first few months if you have recently started using birth control pills. You also may have bleeding if you do not take your pills at a regular time each day. An IUD (intrauterine device) also may increase your chances of spotting or heavy periods.
  • Infection: an infection of the pelvic organs (vagina, cervix, uterus, fallopian tubes, or ovaries) may cause vaginal bleeding, especially after intercourse or douching. Sexually transmitted diseases (STDs) can also be the cause of infection.
  • Thyroid abnormalities: sometimes abnormalities in the thyroid gland can cause irregular bleeding, usually resulting in less frequent periods.
  • Ovarian cyst: as an ovarian cyst develops it often will interfere with the production of hormones from the normal ovarian tissue. As a result of this abnormal hormone production, the cells lining the uterus start to break down and shed irregularly, resulting in irregular bleeding. Though ovarian cysts affect women of all ages, they occur most often during a woman’s childbearing years.
  • Heavy exercise or physical activity: strenuous exertion over extended periods of time can cause irregular bleeding. Serious athletes who train vigorously sometimes will notice more irregular cycles.
  • Other: abnormal bleeding can occur due to a host of other causes including polycystic ovarian syndrome, fibroids, polyps, endometriosis, cervical pre-cancer and cancerous changes, sexual abuse, foreign object in the vagina, breast-feeding and diabetes. Many of these causes will be explored in future content to be added to this site.

An additional note specifically concerning abnormal bleeding in women of menopausal age: in women who have not had a menstrual period for 12 months and are not taking hormones, vaginal bleeding is almost always abnormal and should be discussed with the appropriate healthcare professional.

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