Heavy, intermenstrual or irregular bleeding

Heavy or irregular vaginal bleeding is not just something you have to live with. For some, vaginal bleeding is minor and tolerable; for others, it is annoying and even debilitating. Heavy or Irregular vaginal bleeding can be an indication of a medical problem. There are many treatment options that can help improve your quality of life.

What’s normal?
Normal menstruation typically occurs every 21 to 35 days and lasts for seven or less days. There is a large range of what can be considered a normal menstrual cycle. It is normal for there to be some variation from cycle to cycle, and a woman’s menstrual cycle often changes over the course of her life. Determining if vaginal bleeding is normal depends on your age and circumstances.

Heavy menstrual bleeding
Heavy menstrual bleeding is when cycles are regular, but bleeding is heavy or prolonged. Bleeding is considered heavy when there is a need to change a pad or tampon every one to two hours because it is completely soaked or if you pass large clots. Bleeding is considered prolonged if it lasts more than eight days.

The most common causes of heavy menstrual bleeding are:

• Adenomyosis — This happens when the cells that normally line the inner walls of the uterus start invading into the muscles of the uterus. This condition often causes heavy and painful periods.
• Bleeding disorder — This is a condition that affects the way blood normally clots. A bleeding disorder is likely if heavy or prolonged menses began at menarche; if there is family history of bleeding issues; if there are signs of a bleeding problem, such as easy bruising; or if taking medications that can prevent normal clotting.
• Fibroids — A fibroid is an abnormal growth of the muscles of the uterus. Approximately 80 percent of women will have fibroids during their lifetime, although not all of these women have bothersome fibroid symptoms.

Intermenstrual bleeding
Intermenstrual bleeding refers to vaginal bleeding at any time during the menstrual cycle other than during normal menstruation.

The most common causes of intermenstrual bleeding include:

• Cancer or precancer — A cancer or a precancerous growth on the uterus or cervix can cause intermenstrual bleeding. This is more likely if a woman had previous abnormal pap smears or if there are other risk factors, such as obesity, family history of uterine cancer or bleeding that has been going on for a long time without evaluation.
• Cesarean scar defect — Two-thirds of women who have had one or, in particular, multiple cesarean births may have a cesarean scar defect, and approximately one-third of women with this condition experience bleeding that starts just after the end of their regular menstruation.
• Contraceptives — Many contraceptive methods used can cause intermenstrual and irregular bleeding, especially in the first few months after starting the method.
• Pelvic infections — Intermenstrual bleeding can be a sign of an infection in the uterus or on the cervix. Women who have infection usually experience pelvic pain or increased vaginal discharge in addition to the bleeding. Pelvic infections are more common in women who are exposed to sexually transmitted infections or in women who recently had childbirth or a surgery on the uterus or cervix.
• Polyps — A polyp is an overgrowth of cells around a small blood vessel and can arise inside the uterus or on the cervix.

Irregular bleeding
Irregular bleeding is when a woman goes through phases of no bleeding that may last for two or more months and other phases with either spotting or episodes of heavy bleeding. Irregular bleeding most commonly is related to abnormal ovulation or what is more commonly known as polycystic ovarian syndrome.

What can you do?
Bleeding concerns should be evaluated if it persists for more than a few months to see if there is an underlying medical problem that needs to be addressed. There are many treatment options depending on the cause. If there is an underlying medical problem causing the bleeding, this will be addressed first.

There are special circumstances where irregular bleeding should be treated sooner rather than later to prevent other complications later in life. If you are concerned about bleeding, consult your health care provider immediately.