What are the Causes of Abnormal Menstrual Bleeding?
What
are the Causes of Abnormal Menstrual Bleeding?-Some women sometimes experience
excessive bleeding when they are menstruating, bleeding during pregnancy or
some days after they have had their normal menstrual bleeding; in addition,
this bleeding may be prolonged, lasting longer than a week.
This
abnormal menstrual bleeding is due to a disruption of the normal hormonal
regulation of the wall of the womb in a menstrual cycle. Normally, during each
menstrual cycle, the ovaries allow some egg-containing structures in them
(follicles) to grow; the wall of the womb is nurtured to also grow in
preparation for a possible pregnancy by a chemical substance (hormone) called
oestrogen. Towards the middle of the cycle (for women with 28 days cycle), one
of the egg-containing structures from one ovary ruptures and expels the egg
(ovulation).
If the woman doesn't have sex around or a few
days after this period, no sperm will be available to fertilize the expelled
egg. The egg gradually breaks down while the growth of the wall of the womb
stops due to the withdrawal of the chemical substance called oestrogen. This
causes the wall of the womb to begin peeling off all the growth it underwent,
resulting in the normal menstrual bleeding every woman has in each menstrual
cycle.
However,
if the chemical substance called oestrogen, which nurtures the growth of the
wall of the womb, refuses to withdraw after the ovulated egg has broken down or
even when there is no ovulation, the wall of the womb will keep growing to a
point where its blood supply will not be enough. This leads to a breakdown of
the wall and excessive bleeding from the womb through the vagina.
Abnormal
menstrual bleeding is caused by different factors depending on the age of the
woman. For girls who attained puberty a few years before the abnormal menstrual
bleeding, ovulation not occurring in a menstrual cycle is a major cause. Also,
bleeding disorders in this age group has been found to be another cause of
abnormal menstrual bleeding. In this case, such a girl may have a history of
excessive normal menstrual bleeding since she first saw her menses; a history
of bleeding disorders in her family; or a personal history of bleeding from any
part of the body without any obvious injury or bleeding from the nose for many
minutes.
The parents in this case must not hesitate to
take their daughter to the hospital to see a gynaecologist where they may be
sent to another doctor called a haematologist with specialty in treating
diseases of the blood.
Abnormal
menstrual bleeding in women who have started having children could be a sign of
a miscarriage of a few weeks old pregnancy, an ectopic pregnancy or it could be
due to non-occurrence of ovulation during a menstrual cycle. Such women will
require the attention of a gynaecologist for emergency treatment which will
likely involve surgery.
Fibroids
and absence of ovulation are the common causes of abnormal menstrual bleeding
in women who are getting towards menopause (late 40s); while the shrinking of
and cancerous transformation of the wall of the womb are the major causes of
abnormal menstrual bleeding in women who have passed through menopause.
Treatment in this case depends on whether it is a fibroid or a cancerous
transformation of the wall of the womb causing the abnormal menstrual bleeding.
The gynaecologist will discuss with the woman on the best treatment options
available, their benefits and risks and allow her make a decision on the
preferred treatment option.
Treatment
with drugs such as the combined oral contraceptive pills or the use of the
copper-containing intrauterine contraceptive device can also result in abnormal
menstrual bleeding as a side effect.
Abnormal
menstrual bleeding, especially the heavy and prolonged menstrual bleeding,
predisposes the woman to an unusual amount of blood loss if it occurs
repeatedly. The woman is also at risk of developing iron deficiency anaemia.
But the greatest danger is the possible transformation of the wall of the womb
to cancer (endometrial cancer) due to the repeated stimulation of the wall by
the hormone, oestrogen. The surgical removal of the womb and ovaries,
especially if the woman has stopped giving birth, may be the best treatment
option in this case.
Treatment
of abnormal menstrual bleeding requires the affected woman visiting a
gynaecologist who will take a detailed medical history from her, carry out a
complete physical examination on her, and conduct several medical
investigations before arriving at the actual cause of the problem. After this,
the doctor will now discuss the various treatment options with her.
For
young ladies experiencing heavy normal menses for the first time and which
probably lasts more than a week, using medications such as ibuprofen available
over-the-counter may help in controlling the bleeding. But the ibuprofen must
be purchased from a good pharmacy and taken according to the dosage
instructions written on the pack or as directed by the pharmacist. In addition,
such ladies should ensure they visit a doctor, preferably a gynaecologist for
full medical attention.
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