It’s not my menses. Why am I bleeding?
FOR a woman, bleeding is an ordinary occurrence every month. However, there are times when vaginal bleeding can be abnormal and a cause for concern. The presence of unexpected blood, whether in small or large amounts, can be frightening. The good news – it’s not necessarily due to a serious condition. But it’s still best to have any abnormal vaginal bleeding checked out by your doctor.
Irregular vaginal bleeding can be a little or a lot – it can range from spotting of small amounts of blood between your menstrual periods to heavy periods that soak up pad after pad. Yet most women experience some irregular bleeding at some point. Sometimes they just bleed a couple of days past the usual length of their periods or they spot a bit of blood between periods. So when is irregular bleeding really abnormal? Here are some clues:
- Bleeding when you are not expecting your menstrual period.
- Having a menstrual flow that is lighter or heavier than what is normal for you.
- Bleeding at an unexpected time in life, such as before age 10, when you are pregnant, or after menopause. But don’t become too alarmed yet. Think about what’s happened in your life just recently. Have you been experiencing extreme physical or emotional stress, or had any recent weight loss or gain? Have you just started using contraceptives such as an intrauterine device
(IUD) or hormonal birth control pills and implants? Are you at the age to begin menstruating or begin menopause? Are you menopausal and on hormone therapy? Are you breastfeeding? All the above conditions could explain some bleeding between periods. If it happens only occasionally and you are not bleeding too heavily, then it is probably quite normal. However, if irregular heavy bleeding happens too frequently, it may indicate more serious conditions.
More often than not, abnormal bleeding is due to non-cancerous conditions such as infections of the vagina, cervix, uterus, fallopian tubes or ovaries. These infections are most commonly introduced by sexually transmitted diseases. There is always the possibility that tumours, polyps or fibroids are causing the bleeding. These growths can occur in the vagina, cervix, uterus or fallopian tubes, and could be benign or cancerous. Bleeding can also be related to hormonal imbalances.
Whether you are expecting a pregnancy or not, you should be aware that bleeding can indicate a problem with the unborn baby. A sudden heavy period may disguise what is actually a miscarriage during an early pregnancy. Heavy bleeding after the 12th week of pregnancy may be due to an infection, ectopic pregnancy (where the foetus is implanted outside the uterus) or a miscarriage. If you experience heavy bleeding in the first few weeks after giving birth or after a therapeutic abortion, it may be because the products of conception are still in your uterus or your uterus has not contracted to its pre-pregnancy size.
Vaginal bleeding in young girls who have not begun menstruating could be a sign of sexual abuse. It is not a guarantee, however, so do have the cause of the bleeding checked out by a doctor before coming to any conclusions. Blood turning up at unexpected times can be scary, but don’t panic. Make a record of when, how much and how often the irregular bleeding occurs. Then see your family physician or gynaecologist. Be sure to tell your doctor if you are on any form of contraceptive or hormone treatment.
If you are pregnant or suspect that you are, go to the doctor immediately if you have vaginal bleeding. If your doctor has ruled out all the normal causes of irregular bleeding, he or she will conduct a few tests to see what is wrong. You may have a pelvic exam, including a Pap smear and laboratory tests, an ultrasound or a pregnancy test. Further tests may include an endometrial biopsy, D&C or hysteroscopy.
If the bleeding is related to a medical condition (such as an infection) or a physical condition (such as an IUD), it can be relieved by treating the underlying condition. If the abnormal bleeding does not appear to be related to an underlying disease or condition, it may be treatable with hormone pills. Another method to treat excessive bleeding is ablation of the uterus lining. However, this method can cause infertility, so get proper advice from your doctor if you wish to still be able to bear children.
At the same time, you may also need to be monitored for anaemia because heavy bleeding can cause iron loss. If this happens, your doctor may prescribe you iron supplements. As mentioned earlier, most irregular vaginal bleeding is not due to a serious condition. However, it’s always a good idea to see your doctor when something out of the ordinary happens.
The Star Newspaper, Sunday July 8, 2007
By Dr NOR ASHIKIN MOKHTAR.