Bleeding or spotting between periods is experienced by many women at various times in their lives. Uterine bleeding is considered abnormal if it happens when you are not expecting a menstrual period or when menstrual flow is lighter or heavier than normal. It is also considered abnormal if it occurs during a life stage when it is unexpected, such as before 10 years of age, during pregnancy or after menopause.
There are many potential causes for abnormal vaginal bleeding and, while it does not necessarily indicate a serious condition, taking precautions by visiting your physician is always a wise choice. Any bleeding during pregnancy, or a possible pregnancy, needs to be evaluated by your physician. Ovulation can cause bleeding mid-cycle between menstrual periods. Perimenopause, the time of hormonal fluctuations leading up to menopause, is often typified by irregular uterine bleeding as menstrual changes occur prior to menopause. Bleeding between periods, excessive menstrual flow, and either more frequent or missed periods are all common symptons of perimenopause.
Other reasons for irregular bleeding can include: uterine fibroids, uterine polyps, adenomyosis, uterine hyperplasia, and uterine cancer. These problems can be evaluated by a pelvic exam, pelvic ultrasound, an endometrial biopsy and, if needed, a dilation and curettage procedure (D& C) with hysteroscopy.
Treatments for abnormal uterine bleeding during perimenopause
During perimenopause, the most common reason for abnormal bleeding is due to changing hormonal levels that prevent ovulation from occurring during some cycles. Regular, but much heavier, periods are very common in the years leading up to menopause. The good news for women in their 40s is that a low dose birth control pill can control bleeding problems and alleviate some of the other symptoms of perimenopause, including hot flashes, night sweats, premenstrual syndrome and even premenstrual headaches when used on a continuous basis. After age 50, hormone replacement therapy (which are lower doses of estrogen and progesterone than the pill) can begin, eventually weaning off hormones altogether as the symptoms of menopause allow.
Perimenopausal women who are not candidates or prefer not to take the birth control pill may benefit from other conservative methods to control bleeding. The progesterone IUD (intrauterine device) is one of these options, and it provides an excellent form of birth control lasting for five years. The device releases a progesterone-like hormone which works to thin the lining of the uterus, resulting in much lighter periods. The IUD is an especially good option for women who need a reversible form of contraception.
Endometrial ablations are minimally invasive procedures that work well to treat heavy bleeding during perimenopause, and may even help some patients avoid a hysterectomy. Ablation procedures heat up the uterine lining, and they are highly successful in decreasing the amount of bleeding, in some cases stopping periods altogether. This procedure is not a birth control method and is only for women who have completed their childbearing.
For women who have been unsuccessful with medical management and less invasive options, a hysterectomy during perimenopause may be the best option for abnormal bleeding. A hysterectomy is the most definitive treatment for abnormal bleeding and may be preferred for women with significant fibroids, adenomyosis and endometriosis.