June 21st, 2012 by Hasham

Vaginal Bleeding Overview

Unexpected bleeding is always a concern for a woman at any stage of life. Bleeding other than a normal menstrual period and even an abnormally heavy period can be great cause for alarm. The medical term for excessive or prolonged vaginal bleeding that occurs at the regular time of the menstrual cycle is known as menorrhagia. Metrorrhagia is the term used to refer to uterine bleeding at irregular intervals, particularly between the expected menstrual periods. Menometrorrhagia is the combination of the two, that is, excessive uterine bleeding, both at the usual time of menstrual periods and at other irregular intervals.

It is important to understand exactly what is causing the bleeding, its origin (uterus, vagina, or some other organ or tissue), and to make decisions about how to control or stop the bleeding.

A woman’s normal menstrual cycle involves a complex series of hormonal events. An egg is released from the ovary; either the egg is fertilized by a sperm and implants in the uterus, or the lining of the uterus is shed each month as the menstrual period. This shedding causes normal menstrual bleeding.

    A normal menstrual cycle is 28 days plus or minus 7 days.

    A menstrual period generally lasts from 2-7 days and has a typical volume of blood and fluid loss of about 2 to 8 (average 5) tablespoons. This corresponds to about eight or fewer soaked pads per day with usually no more than 2 days of heavy bleeding.

Menorrhagia (heavy menstrual bleeding)

Definition

Menorrhagia is the medical term for menstrual periods in which bleeding is abnormally heavy or prolonged. Although heavy menstrual bleeding is a common concern among premenopausal women, most women don’t experience blood loss severe enough to be defined as menorrhagia.

With menorrhagia, every period you have causes enough blood loss and cramping that you can’t maintain your usual activities. If you have menstrual bleeding so heavy that you dread your period, talk with your doctor. There are many effective treatments for menorrhagia.

Symptoms

The signs and symptoms of menorrhagia may include:

Soaking through one or more sanitary pads or tampons every hour for several consecutive hours
Needing to use double sanitary protection to control your menstrual flow
Needing to wake up to change sanitary protection during the night
Bleeding for a week or longer
Passing large blood clots with menstrual flow
Restricting daily activities due to heavy menstrual flow
Symptoms of anemia, such as tiredness, fatigue or shortness of breath

When to see a doctor
Seek medical help before your next scheduled exam if you experience:

Vaginal bleeding so heavy it soaks at least one pad or tampon an hour for more than a few hours
Irregular vaginal bleeding
Any vaginal bleeding after menopause

Causes

In some cases, the cause of heavy menstrual bleeding is unknown, but a number of conditions may cause menorrhagia. Common causes include:

Hormonal imbalance. In a normal menstrual cycle, a balance between the hormones estrogen and progesterone regulates the buildup of the lining of the uterus (endometrium), which is shed during menstruation. If a hormonal imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding.
Dysfunction of the ovaries. If ovulation does not occur in a menstrual cycle (anovulation), progesterone is not produced. This causes hormonal imbalance and may result in menorrhagia.
Uterine fibroids. These noncancerous (benign) tumors of the uterus appear during your childbearing years. Uterine fibroids may cause heavier than normal or prolonged menstrual bleeding.
Polyps. Small, benign growths on the lining of the uterine wall (uterine polyps) may cause heavy or prolonged menstrual bleeding. Polyps of the uterus most commonly occur in women of reproductive age as the result of high hormone levels.
Adenomyosis. This condition occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding and painful menses. Adenomyosis is most likely to develop if you’re a middle-aged woman who has had children.
Intrauterine device (IUD). Menorrhagia is a well-known side effect of using a nonhormonal intrauterine device for birth control. When an IUD is the cause of excessive menstrual bleeding, you may need to remove it.
Pregnancy complications. A single, heavy, late period may be due to a miscarriage. If bleeding occurs at the usual time of menstruation, however, miscarriage is unlikely to be the cause. An ectopic pregnancy — implantation of a fertilized egg within the fallopian tube instead of the uterus — also may cause menorrhagia.
Cancer. Rarely, uterine cancer, ovarian cancer and cervical cancer can cause excessive menstrual bleeding.
Inherited bleeding disorders. Some blood coagulation disorders — such as von Willebrand’s disease, a condition in which an important blood-clotting factor is deficient or impaired — can cause abnormal menstrual bleeding.
Medications. Certain drugs, including anti-inflammatory medications and anticoagulants, can contribute to heavy or prolonged menstrual bleeding. Improper use of hormone medications also can cause menorrhagia.
Other medical conditions. A number of other medical conditions, including pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease, may be associated with menorrhagia.