Abnormal vaginal bleeding in non-pregnant women has a wide variety of causes, ranging from mental factors to serious and life-threatening conditions. What are the most common causes of vaginal bleeding?

Abnormal vaginal bleedingincludes spotting or bleeding in postmenopausal women, irregular bleeding during puberty, and heavy and irregular bleeding in mature women. The causes of irregular bleeding depend on the age and phase of the menstrual cycle. Irregular bleeding may also occur in women taking anticoagulant medications.

Abnormal bleeding during puberty

Your bleeding may be irregular in the first 5 years after your first period. However, this must always be checked, because even in this period of life, women may indicate abnormalities in the reproductive organ or a cancerous disease. However, the most common irregular bleeding during puberty is associated with anovulatory cycles, in which the ovary does not release an egg.

Non-ovulatory cycles are the cause of functional bleeding. They are common in adolescence and in perimenopausal women. The normal menstrual cycle is the result of the proper functioning of the feedback system between the hypothalamus, pituitary gland and ovaries, releasing an egg ready for fertilization and producing a lining of the womb capable of accepting a fertilized egg.

The pituitary gland secretes follicle-stimulating hormone (FSH), a hormone that stimulates the development of follicles (structures surrounding the egg) and provokes the release of estrogens.

Estrogens stimulate the endometrium to grow, reduce the concentration of FSH and stimulate the pituitary gland to more intensively produce luteinizing hormone (LH). This situation is called the LH kick.

The high concentration of LH stimulates the Graaf follicle to mature and release the egg. The ruptured follicle transforms into a corpus luteum, a yellowish structure that releases progesterone and estrogens.

If an egg is not fertilized, both of these hormones inhibit the production of FSH and LH. After lowering the LH concentration, the corpus luteum disappears and the concentration of estrogens and progesterone disappearsfalls, causing the lining of the womb to peel off during menstruation.

Often times, this complex feedback mechanism is disrupted, leading to anovulation. And without ovulation, there is no corpus luteum and no progesterone. Follicular-stimulated estrogen secretion causes thickening of the lining of the womb, which may peel off. Irregular bleeding occurs as a result.

Abnormal bleeding in mature women

Abnormal bleeding in mature women may be associated with anatomical defects, the use of certain methods of contraception, and with systemic diseases.

Anatomical abnormalities may appear in:

  • the vagina itself (rupture, cancer, atrophy of the mucosa)
  • cervix (polyps, cervical cancer, intrauterine endometritis, uterine fibroids, cervicitis)
  • in the fallopian tubes (ectopic pregnancy, fallopian tube cancer)
  • ovaries (ovarian cancer, corpus luteum cyst)

Vaginal bleeding may be the only symptom of any of these conditions.

It's good to know that women with polyps have cramp pains between periods. Pain can also be caused by degenerating uterine fibroids, endometritis, corpus luteum cyst and intrauterine endometritis.

Mature women experience bleeding or heavy spotting after intercourse. If so, the woman should be screened for polyps and cervical cancer. Bleeding after intercourse may also indicate vaginal mucosa atrophy or inflammation of the cervix.

Gentle bleeding between periods is a symptom of ovulation in some women. But they are also very characteristic of:

  • endometritis
  • endometrial cancer
  • incomplete miscarriage (situation where there are remains of fetal tissue in the uterus)

Bleeding also occurs with an ectopic pregnancy that requires immediate medical attention.

Another cause of uncontrolled bleeding is the persistent corpus luteum. It lasts longer than 10-16 days, which makes your period delayed.

Systemic diseases

It is very rarely said that systemic diseases can contribute to the occurrence of abnormal bleeding.

Hypothyroidism (deficiency of thyroid hormones) and hyperprolactinemia (overproduction of prolactin) can lead to impairment of the luteal phase, which causes more frequent periods. The length of the cycle in such a situation is 16-22 days. There may also be anovulatory bleeding.

In turnstress, anxiety, anorexia and kidney disease make periods less frequent or stop altogether. Very heavy periods can be the result of a bleeding disorder, hypothyroidism or systemic lupus.

Contraception

Has a big influence on the type of bleeding. An IUD lengthens her period and causes a woman to lose more blood. Oral contraceptives reduce menstrual bleeding, as the low estrogen content in most preparations makes the endometrium thinner than in women who are not using contraception and are ovulating.

You need to be aware that both forms of contraception can cause bleeding between periods. If this happens, talk to your gynecologist about changing the tablets or removing the IUD.

Abnormal bleeding in the perimenopausal period

The physiology of menstrual cycles is very similar in adolescent and perimenopausal women. At the end of her childbearing years, many women find that their menstrual rhythms change.

Average cycle length for women in their 20s is 32 days, for women over 35 it is only 28 days or less. The cycles are shorter because the body is running out of progesterone produced by the corpus luteum, which shortens the luteal phase of the cycle. In addition, the poorer quality and diminishing number of follicles limit the production of estrogen, and thus the surge of LH and ovulation.

Continuous endometrial stimulation by low estrogen levels that is not counterbalanced by progesterone leads to endometrial hyperplasia that peels off at irregular intervals.

Perimenopausal women, as in adolescence, go through a phase of functional bleeding until the menopause and menstrual bleeding are stopped.

Bleeding and spotting in the postmenopausal period

Abnormal bleeding can have many different causes. Bleeding during this period of a woman's life is associated with obesity, vaginal trauma, and medications (e.g. hormone replacement therapy, anticoagulants). Older women with vaginal atrophy may bleed after intercourse.

Obesity can cause spotting or bleeding because obese women have high estrogen levels. And this is because fat cells convert the androgens from the adrenal glands into estrogens. This situation leads to endometrial hyperplasia, a condition that not only causes irregular bleeding, but can be a signal of developing cancer in older womenuterine body.

Women using hormone replacement therapy have irregular bleeding, especially at the beginning of the treatment. Taking estrogen daily with a low dose of progestogen causes irregular and unpredictable bleeding that lasts for 3-6 months.

If bleeding continues for more than six months, find the anatomical cause. If a woman is taking estrogen daily and taking 10-12 days of progestogen supplementation, it is normal to experience slight bleeding after stopping the progestogen.

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Abnormal bleeding - diagnosis

Every woman who has abnormal bleeding should be looked after by a gynecologist. The latter should make sure that the bleeding is not coming from the bladder (urethra) or the anus.

Premenopausal women should get a pregnancy test, even if the risk of pregnancy is low. It is also important to perform blood tests, bacteriological tests of swabs from the cervical canal for chlamydia and gonorrhea, pap smear tests and tests of liver function, thyroid gland and blood hormone levels.

Ultrasound examination allows you to exclude or confirm the presence of fibroids that may cause bleeding.

In postmenopausal women, an endometrial biopsy is required to rule out or confirm cancer. If the biopsy shows no endometrial cancer, a test should be performed to see if there are any tumors of the adrenal glands or ovaries that produce oestrogens.

Abnormal bleeding - treatment

Treatment must be tailored to the cause of the abnormal bleeding.

In the case of systemic or chronic diseases (thyroid, kidney, liver), the primary treatment is to control the primary disease.

Bleeding caused by anovulatory cycles is treated according to the age of the woman. In adolescence, observation is very often sufficient, as most women find that bleeding is regulated by nature itself. Very heavy bleeding that leads to anemia is treated with oral contraceptives for six months. The next step is to check if the cycles are back to normal.

Abnormally frequent periods resulting from a shortened luteal phase can be treated with oral contraceptives or suppository progestogens, administered from the moment of ovulation.

Bleeding resulting fromshortenings of the follicular phase (first phase of the cycle) normalize spontaneously.

In the perimenopausal age, progesterone with estrogens is used until the natural menopause. If this treatment is ineffective, the doctor may exfoliate the endometrium. The procedure is performed through the vagina and involves laser removal of the uterine mucosa.

In older women, removal of the uterus is considered in the event of severe and unmanageable hemorrhages.

Any woman with abnormal bleeding should remember that the cause of bleeding may be cancer. This is especially true for older women over 65 because at this age they are at greater risk of endometrial and ovarian cancer.

About the authorAnna Jarosz A journalist who has been involved in popularizing he alth education for over 40 years. Winner of many competitions for journalists dealing with medicine and he alth. She received, among others The "Golden OTIS" Trust Award in the "Media and He alth" category, St. Kamil awarded on the occasion of the World Day of the Sick, twice the "Crystal Pen" in the national competition for journalists promoting he alth, and many awards and distinctions in competitions for the "Medical Journalist of the Year" organized by the Polish Association of Journalists for He alth.

Category:

Female diseases