Abnormal Vaginal Bleeding

Abnormal vaginal bleeding is defined as any bleeding that occurs other than the regular menstrual bleeding each month. These types of bleeding can be spotting between two periods or heavier and more prolonged bleeding than the routine menstrual flow.

Normal menstrual bleeding or menstruation indicates the uterus preparing for a new reproductive cycle, occurring every 21-35 days. It lasts for 3-7 days, and a daily discharge of 3-4 pads is considered normal. The menstrual cycle tends to be longer near menopause and in young girls. In these ages, the bleeding amount can be heavy without any pathology.

Abnormal vaginal bleeding can be observed due to reasons related to the reproductive system or medical factors. These reasons include pregnancy, miscarriage or threatened miscarriage, ectopic pregnancy, adenomyosis, intrauterine devices or birth control pills, inflammation of the uterus or cervix, fibroids, polyps, endometrial hyperplasia (thickening of the uterine wall), cancers (uterine, cervical, and vaginal cancers), and polycystic ovary syndrome.

Moreover, it can be seen in thyroid gland disorders, severe liver and kidney diseases, diseases affecting coagulation, those using hormone therapy for menopause, and individuals using tamoxifen for breast cancer.

For diagnosis, patients should be questioned about their menstrual cycle and family history. A detailed gynecological examination should be conducted. Pregnancy tests, blood count, and hormone level assessments may be performed in deemed necessary cases. Pelvic organs should be evaluated using ultrasound. In cases where further imaging is required and there is suspicion, magnetic resonance imaging (MRI) can be used. For patients suspected of having fibroids or polyps in the uterus, a saline infusion sonohysterography (SIS) can be performed under ultrasound guidance. Hysteroscopy can be used to visualize the inside of the uterus. In suspicious cases, a biopsy can be taken from the inside of the uterus using a thin catheter.

Treatment involves medical and surgical approaches tailored to the cause.