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Gynaecology Care: Ten Questions You Might Have About Abnormal Vaginal Bleeding

Many women at some point in their lives face abnormal vaginal bleeding – and this bleed from such a delicate area can often bring unwanted worry and stress. The truth is, sometimes abnormal bleeding is common and not a cause for concern, but unfortunately sometimes it can be a sign of something more serious.

To help women better understand the causes of abnormal vaginal bleeding – we’ve polled a selection of women to find out some common questions, and have asked leading Harley Street Gynaecologist Dr Eskander to provide us with much wanted answers.

Vaginal Bleeding: What is considered abnormal?

1. What is considered irregular or abnormal vaginal bleeding and what should you do if you experience it?
A woman’s period is considered regular if it occurs around the 28 day mark – which for a long cycle can mean every 28 to 42 days and for a short cycle – 21 to 28 days. Should your period recur outside this range, it is then considered irregular and it should be investigated to find the reason why. Common reasons are irregular ovulation, non-ovulation due to polycystic ovarian disease, thyroid problems, and functional cysts on the ovary or the presence of an intrauterine polyp or fibroid.

2. Is it normal to bleed after sex?
Bleeding after sex is referred to as postcoital bleeding. This is abnormal and should be investigated without delay. It is often due to an abnormality on the cervix and it is important to rule out polyps, chlamydia, and cervical cell abnormality. Initially, a clinical examination, chlamydia test and smear will be performed. However, if these are negative and the bleeding persists, a Colposcopy is recommended. A Colposcopy is more accurate than a cervical smear in ruling out cell abnormality.

3. My period is heavier than normal, is that cause for concern?
Every woman has a flow that is normal to them, so when there is a sudden change in the amount of flow a woman personally experiences (providing she has not recently come off of the pill) the situation should be investigated. If the amount of blood loss is excessive it should treated right away to avoid anaemia.

4. I am spotting between periods, what does this mean?
The most common reason for abnormal bleeding between periods is temporary non-ovulation. This may settle spontaneously or may require correction by hormone tablets. However, if it is accompanied by pain, it is important to exclude ectopic pregnancy – and if it persists for more than one month, an ultrasound should be performed to rule out a polyp or fibroid within the uterus.

5. I am trying to become pregnant but am often spotting between periods – will this interfere with conception?
What is abnormal vaginal bleeding?Spotting could be due to a local abnormality such as a polyp inside the uterus or a functional cyst on the ovary. A polyp may prevent implantation of the foetus and a cyst may interfere with ovulation. Spotting could also be a sign of inadequate hormone control of the cycle. For example, lack of oestrogen or progesterone due to deficient ovulation. This can be easily corrected by induction of ovulation or progesterone supplementation.

6. What gynaecological conditions are associated with irregular vaginal bleeding?
Abnormal bleeding may be due to any abnormality along the genital tract and it is important to rule out cervical polyp, uterine polyp, uterine fibroids, cysts on the ovaries and ovulation problems. In women over 40 and those who have experienced menopause, cancer of the uterus must also be ruled out.

7. Does irregular bleeding mean you have cancer?
Irregular bleeding does not mean you have cancer, however it is important to rule out cancer of the uterus through careful examination and transvaginal ultrasound in all women over 40. This is especially the case if the bleeding does not stop after simple treatment for women of all ages.

8. I am pregnant and experiencing bleeding – is this normal or should I be worried?
Bleeding in pregnancy is abnormal and should be investigated. A vaginal examination will be able to rule out a polyp on the cervix. In the first 12 weeks, the most common reason is miscarriage or early pregnancy failure which can be diagnosed by transvaginal ultrasound.

Unexplained mild bleeding is common in IVF pregnancies and will usually settle spontaneously. After 12 weeks, a low lying placenta is a common reason for bleeding – many of which will rise up as pregnancy advances. If the placenta remains low, it can lead to heavy bleeding which can be serious and life threatening to both the mother and the foetus. Delivery is usually then planned by Caesarean section before 38 weeks.

Another reason for abnormal bleeding is placental abruption (bleeding behind the placenta) and this is usually associated with severe abdominal pain.

9. What is normal versus abnormal bleeding after childbirth?
Bleeding after childbirth is common and the blood usually remains red for about two to three weeks following birth. Thereafter it turns brown and yellow (this is called lochia). Any bleeding which does not fit this pattern can be considered abnormal.

10. I am over 40 and experiencing abnormal vaginal bleeding – what does this mean?
Although abnormal bleeding and irregular cycles are common as a result of irregular ovulation after 40, it is important to have an examination by a specialist and a transvaginal scan to rule out cancer of the uterus.

We thank Dr Eskander of The Gynae Centre, for providing specialist knowledge for this article.

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