At Diana Health, we want you to be educated about your menstrual cycle. In fact, over the years, we’ve written several blogs about menstruation to which you can find links below. Usually, women do not seek out help when their menstrual cycle is typical and they are not having any problems. However, you may want to know more about your menstrual cycle, even if it is regular and typical, as it can be used as a “vital sign” for health. For more information about using your Menstrual Cycle as a Vital Sign or to review what is considered a “typical” or “regular” menstrual cycle, visit this blog post.
We often have women who come to see us due to irregular bleeding, which is fairly common in reproductive-age women and may negatively impact their quality of life. This is sometimes referred to as atypical bleeding, which is vaginal bleeding that happens outside of the typical menstrual cycle. It can also be defined as vaginal bleeding that happens at a different time than a “withdrawal bleed” that occurs on the “off” weeks of cyclical hormonal contraception (e.g., oral contraceptive pills). Irregular bleeding can happen at different times across the lifespan, and can sometimes require a check-up, so it’s important to know what to look for and what to do if you’re experiencing irregular bleeding.
How to spot it:
Bleeding can be considered irregular, atypical, or abnormal in several ways, including the following:
- Bleeding that lasts for longer than seven days
- Bleeding that is so heavy that it soaks one or more tampons or pads in an hour
- Menstrual cycles (the start of one menstrual period to the start of the next) that are irregular for a woman (differing more than a week)
- Menstrual cycles that are less than 21 days or more than 35 days
- Bleeding that occurs between menstrual periods
- Excessive pelvic pain or cramping during menstruation
Potential Causes: There are several potential causes for bleeding, hormonal, structural and infectious, each which have different implications. To learn more about the different causes of irregular bleeding, see this blog post.
What to do: If you are having irregular bleeding, it’s important to see your Diana Healthcare provider, Ob-Gyn, or primary care provider. If the bleeding is minimal, you are not pregnant, and there are no other worrisome symptoms, you can monitor the bleeding with a period tracker, record any associated symptoms, and monitor the bleeding. For more information about when to seek emergency care for bleeding, see this blog on Menstrual Bleeding and Blood Clots.
Evaluation for Irregular Bleeding: Because there are so many different reasons for irregular bleeding, the evaluation will differ based upon your symptoms. An evaluation will typically include a history and physical exam, a pelvic exam, labs, and possibly a pelvic ultrasound to evaluate the lining of the uterus and look for any structural causes. Sometimes a hysteroscopy or colposcopy may be warranted.
Treatment: The treatment, if any is needed, for irregular bleeding will depend upon the underlying cause of the bleeding, what the evaluation has shown, and what you decide with your healthcare provider. Irregular bleeding is often controlled with hormonal treatment. Sometimes procedures such as an endometrial ablation or hysterectomy may be used. For more information on these treatments, visit these blogs on Endometrial Ablation and Hysterectomy. In some cases, lifestyle behaviors may impact abnormal bleeding too and more information can be found in the Abnormal Bleeding and Lifestyle Medicine blog.
If you have any questions about menstruation, abnormal vaginal bleeding, or other women’s health topics, book a visit with Diana Health. We are here to educate, empower, and support you along your wellbeing journey.
