What is abnormal vaginal bleeding?

Bleeding from the vagina that is not part of your monthly periods (examples):

• Heavy bleeding
• Prolonged bleeding
• Associated with pain
• Bleeding with blood clots

If you experience episodes of bleeding, ask yourself these questions :

1. Am I pregnant?
2. What is the pattern of the bleeding?
   • Duration
   • Any blood clots
   • Pain
   • Number of pads used

What are the causes?

If you are in the reproductive age :

• Birth control pills and injection (bleeding between periods)
• Infections
• Miscarriage or problems with pregnancy
• Fibroids
• Ovarian cysts
• Endometriosis (back flow of menses debris into fallopian tubes)
• Dysfunctional uterine bleeding (DUB)
• Cancer of ovaries

If you are menopause :

• Endometrial cancer
• Cancer of ovaries
• Cancer od cervix, vagina or vulva

Others :

• injury to vagina or reproductive tract during rape or surgery
• bleeding disorders that affect the whole body, such as leukaemia and clotting problems

What should I do?

The earlier you seek treatment, the better is the outcome.

If the bleeding is heavy and prolonged, you may experience the following symptoms :

• feeling lethargic
• fainting spells
• nausea and vomiting

Here are the examinations that the doctor will carry out :

• physical examination :
  • blood pressure, pulse / heart rate, respiratory rate, body temperature
  • heart and lungs
  • thyroid gland (swelling in front of the neck)
  • breasts
  • abdomen

• pelvic examination (groin area) :
  • inspection of the vagina
  • vagina examination
  • Pap smear
  • Biopsi

• blood tests : blood count to exclude low blood cell count (anaemia)
  • blood count to exclude low blood cell count (anaemia)
  • thyroid function test
  • liver function test
  • kidney function test
  • hormonal test (e.g. FSH)

• Urine Pregnancy Test (UPT)
• Ultrasound

How is abnormal vaginal bleeding treated?

The treatment given will depend on the underlying cause.

• hormonal medication (for DUB)
  • e.g. Progesterone or birth control pills, intrauterine system (IUS) – Mirena
• antibiotics, if bleeding is caused by infections
• laparoscopy (i.e. making a small cut below your umbilicus and inserting a fiber optic tube to visualise inside your abdomen) for endometriosis
• D & C (dilatation and curettage) for miscarriage
• Surgery (e.g. if bleeding uncontrolled)

Where can I get help ?

• All government clinics and hospitals
• Private clinics and hospitals

FAQs

1. What is normal vaginal bleeding (period)?
   It is the periodic blood that flows from the uterus through the vagina. It is also called menorrhoea.
   Normal period occurs every 21 to 35 days and last between 2 and 7 days. The average blood loss during periods is 20 to 60 milliliters.
2. What causes vaginal bleeding during early pregnancy?
   Vaginal bleeding that occurs during the first 22 weeks of pregnancy due to :
   • injury
     • falls
     • direct blow at abdomen
   • non injury
     • miscarriage
     • ectopic pregnancy (i.e. pregnancy outside the uterus cavity)
     • molar pregnancy
3. What is menorrhagia?
   It is a condition when you have heavy bleeding during your periods. Usually the amount of blood loss is more than usual and you have to change sanitary pads frequently.
   It may or may not be associated with other complaints such as cramping like pain (dysmenorrhea), giddiness, fatigue etc.
   If there is too much blood loss, you can get fainting attack and collapse. Hence, you must not wait too long and seek early treatment.

References

http://www.who.int/reproductivehealth/impac/symptoms/ vaginal_bleeding_early_S7_S16.html