Uterine Bleeding

Uterine bleeding is defined as abnormal bleeding from the uterus that is not related to the normal menstrual period. It differs from normal menstruation in both timing and the amount and duration of bleeding.

Uterine bleeding can occur at various periods of the cycle, between periods, before menopause, or even after it. The severity of the problem varies from light blood spotting to heavy bleeding that can significantly affect a woman's quality of life.

• Hormonal Disorders
  • Hormonal imbalances are the most common cause of uterine bleeding. Fluctuations in estrogen and progesterone levels can disrupt the normal menstrual cycle, causing unscheduled bleeding.
  • Polycystic ovary syndrome (PCOS) is one of the main hormonal disorders associated with uterine bleeding. Women with PCOS often have irregular cycles and may present bleeding between periods.
• Structural Problems of the Uterus
  • Fibroids are benign tumors that develop in the muscular wall of the organ. Depending on their location and size, they can cause heavy uterine bleeding, prolonged periods, and pain.
  • Endometrial polyps are also a common cause of abnormal bleeding. These are small protrusions of the uterine mucosa that can bleed irregularly.
  • Adenomyosis, a condition where the endometrium develops inside the muscular wall of the uterus, can also cause heavy and painful periods.
  • Endometrial hyperplasia and endometrial cancer manifest with vaginal bleeding. All women with uterine bleeding, whether of reproductive age or in menopause, must be examined.
• Pharmaceutical Factors
  • Certain medications can affect the menstrual cycle and cause uterine bleeding. Anticoagulant drugs, certain antidepressants, and hormonal contraception may have abnormal bleeding as a side effect.
  • Use of copper intrauterine devices (IUD) can also initially cause irregular bleeding, especially during the first months after placement.
• Basic Pathological Conditions
  • Various pathological conditions can contribute to uterine bleeding. Thyroid disorders, diabetes mellitus, and liver diseases can affect blood clotting ability.
  • Hemostatic disorders, such as Von Willebrand disease or hemophilia, can cause prolonged and heavy bleeding.

Uterine bleeding can manifest in various ways. It can be light, between periods, or heavy with large amounts of blood. Duration can vary from a few hours to several days.

Besides bleeding, women may present other symptoms. Abdominal or pelvic pain is common, especially when uterine bleeding is related to structural problems such as fibroids.

Fatigue and weakness can occur if bleeding is frequent or heavy, leading to iron-deficiency anemia. Other symptoms include dizziness, tachycardia, and discomfort.

Diagnosis of uterine bleeding begins with detailed history and physical examination. The gynaecologist will request information about the frequency, duration, and intensity of bleeding, as well as any associated symptoms.

Laboratory tests are an integral part of the diagnostic process. Complete blood count can reveal anemia due to recurrent bleeding.

Hormonal tests include measurements of estrogen, progesterone, LH, FSH, and thyroid hormone levels. These tests can reveal hormonal imbalances contributing to the problem.

Pelvic ultrasound is the first choice for imaging examination. It can identify structural abnormalities such as fibroids, polyps, or ovarian cysts.

Magnetic resonance imaging (MRI) can provide more detailed information for complex conditions or when better imaging of structural abnormalities is needed.

Treatment options vary depending on diagnosis.

It is important to seek immediate medical help if you experience cycle disturbance, prolonged or heavy period, or bleeding unrelated to the period. All women in menopause must be investigated immediately even with suspected vaginal bleeding.

Uterine bleeding is a complex gynecological problem affecting many women. Understanding the causes and timely diagnosis are key to successful management. With modern treatment options, most women can find an effective solution that will improve their quality of life.

Regular monitoring by a specialist gynecologist and lifestyle adaptation can significantly contribute to managing this condition. Remember that every woman is unique, and treatment must be adapted to individual needs and circumstances.

Kostis Nikolopoulos applies modern diagnostic and therapeutic methods.

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