Women’s health: Abnormal bleeding – a cause for concern?

Dr Niki Baxter

Dr Niki Baxter - Credit: Archant

Promotional Feature: Dr Niki Baxter runs a friendly Women’s Health Clinic at Claremont Private Hospital in Sheffield, where she regularly sees ladies with all types of common health concerns including abnormal or unexpected vaginal bleeding. Here she shares a straightforward guide about abnormal bleeding.

What Women Should Know...

Most women have a period every month. This pattern is controlled by a hormonal cycle and varies slightly from woman to woman.

Abnormal bleeding can be:

• Irregular bleeding in between periods

• Bleeding after sexual intercourse

• Excessively heavy or prolonged periods

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• Bleeding after the menopause.

So what are the possible causes?

Contraception

There are a variety of contraceptive methods available and although very effective at preventing pregnancy, some women may experience bleeding problems.

• Combined oral contraceptive methods – some women choose to use several packets of the pill back-to-back to avoid having a period. This is a medically-safe practice but if more than 3 packets are used without a break, some breakthrough bleeding can occur. This may also happen with prolonged continuous use of the vaginal ring or contraceptive patch.

Progestogen-only contraception – the mini-pill, the hormone coil (Mirena®) and the implant can all cause irregular bleeding patterns, especially in the first few months of use.

• Copper coil – this does not usually cause irregular bleeding as it is hormone-free, but can make periods heavier.

Abnormalities of the womb

• Polyps may occur inside the womb, arising from the womb lining, and can cause bleeding irregularities.

• Fibroids are growths arising from the muscle of the womb. They are usually benign, like polyps, but can cause distortion of the shape of the womb and bleeding problems.

Both polyps and fibroids can be removed surgically and some may even be done in an outpatient setting.

Abnormalities of the cervix

• A cervical ectropion (when the cells on the cervix become more fragile due to hormonal influence) can bleed, especially during intercourse. This can be treated in clinic using a freezing technique called cryotherapy.

• Cervical polyps are benign growths which sometimes protrude through the cervix into the vagina. They may bleed when traumatised (for example during sex) and are usually removable in clinic.

• Bleeding can also be the first sign of something more serious like abnormal cells which can lead to cancer, so a smear test is done to make sure the cervix is healthy.

Infection

Sexually-transmitted infections (STIs) like Chlamydia and Gonorrhea cause inflammation of the cervix and vagina which leads to bleeding. STIs are diagnosed on examination or with swab tests and are treated effectively with medication.

Post-menopause

Women approaching the menopause often describe their periods as becoming heavier or more erratic. This is usually a normal result of the hormonal changes, however, other causes, e.g. polyps, fibroids and, more rarely cancer, should be excluded.

After the menopause, periods stop. Any woman who experiences a bleed one year or more after the last period should seek immediate advice and be investigated fully.

Pregnancy

Pregnant women can occasionally continue to menstruate or, more commonly, experience irregular spotting in the initial stages. Bleeding can be normal but may be a sign of impending miscarriage or an ectopic pregnancy so it’s always advisable to get checked out if you’re worried.

Trauma

Injury to the vulva or vagina during intercourse or with foreign objects can cause bleeding. Continuous itching, sometimes caused by conditions like thrush, can lead to breaks in the skin which can also go on to bleed.

Medications

Anticoagulant drugs are prescribed to thin the blood in people who have suffered with, or are at risk of, developing a clot. However, they occasionally cause increased bleeding. Some anti-depressants and anti-epileptic drugs have also been known to interfere with the menstrual cycle.

Other medical conditions

Periods can be disrupted by some medical conditions.

• Hypothyroidism (low thyroid levels) may cause periods to be heavier, whereas Polycystic Ovarian Syndrome (POS) makes periods irregular. Women with bleeding disorders such as Leukemia or Von Willebrands disease can have abnormal bleeding too.

• Excessive weight loss may reduce or stop menstruation and women who do extreme exercise sometimes describe irregular spotting in between periods.

So what are the investigations for abnormal bleeding?

Examination

Anyone with abnormal bleeding should have a full examination, including an internal pelvic exam. This will allow the doctor to inspect the vulva, vagina and cervix.

Swabs

Swab tests are performed if indicated and will diagnose infections if present, which can then be treated.

Cervical screening test (previously called a smear test)

This is used to detect abnormal cells on the cervix.

Ultrasound

This scan gives a grey-scale image of the pelvic organs and can diagnose masses, including ovarian cysts, polyps and fibroids.

Hysteroscopy

Hysteroscopy is the gold-standard investigation to look for womb-related causes of bleeding. A small telescope is passed into the womb which allows the doctor to look at the lining directly and diagnose polyps and fibroids. This can now be done in the outpatient setting and does not require a general anaesthetic. In addition, a biopsy of the womb can be taken at the same time, which can then be examined in the laboratory to look for abnormalities of the lining cells.

To sum it up...

In most cases, no cause for the bleeding symptoms is found. There are a number of treatment options available to help lessen bleeding and improve quality of life. These can be commenced after investigation and women no longer need to live with intolerable symptoms.

For more information about Dr Baxter’s Women’s Health Clinic, please contact the Private Patient Team at Claremont Private Hospital on 0114 263 2114 or visit www.claremont-hospital.co.uk/consultants/niki-baxter

Claremont Private Hospital has been at the heart of the Sheffield community for more than 60 years providing first class private healthcare in a safe, comfortable and welcoming environment.