TL;DR:
- Normal menstrual cycles last 21-35 days with bleeding <7 days and blood loss <80 ml. Severe pain or irregular/heavy bleeding is abnormal.
- Types of abnormal bleeding:
- Menorrhagia: Heavy (>80 ml) bleeding >7 days.
- Menometrorrhagia: Irregular, long, heavy bleeding.
- Polymenorrhea: Frequent cycles (<21 days).
- Oligomenorrhea: Infrequent cycles (>35 days).
- Amenorrhea: No menstruation >6 months.
- Metrorrhagia: Bleeding between cycles.
- Common causes: Hormonal imbalances, uterine/ovarian disorders, pregnancy-related issues, stress, infections, coagulopathies, medications, or systemic conditions.
- Stress disrupts cycles by raising cortisol & prolactin levels.
- Diagnosis involves history, physical exams, blood tests, imaging, or biopsies.
- Treatments vary: Hormones, NSAIDs, antibiotics, or surgery for severe cases. Evaluate all abnormal bleeding with a doctor.
Genital tract bleeding physiologically begins the menstrual cycle. However, sometimes they are a symptom of a serious health problem in women. Particularly worrisome are irregular, heavy or unexpected bleeding, which can signal the presence of various gynecological disorders and functional conditions. Understanding the causes of the disorder, as well as proper diagnosis and treatment, are key to ensuring women's health and good quality of life.
How to distinguish normal bleeding from pathology?
Physiological bleeding caused by the menstrual cycle occurs regularly and usually lasts up to 7 days. The cycle itself lasts from 21-23 days to 35 days counting from the first day of menstruation. It is an outward manifestation of the normal functioning of the ovaries. Abnormal bleeding is most often unexpected, occurs too often, is too heavy or has an alarming appearance. Normal menstrual bleeding is characterized by a moderate amount of blood, which usually does not exceed 80ml. Although mild or moderate discomfort or abdominal pain are normal during menstruation, severe pain that prevents normal function may indicate health problems. Abnormal bleeding can often be associated with other symptoms, such as pain during intercourse, lower abdominal pain outside the menstrual period, changes in body weight, changes in mood, increased thirst, fatigue or other symptoms.
How do we divide irregular reproductive tract bleeding?
Speaking of abnormal genital tract bleeding, we can distinguish several gynecological terms, which include the duration of the disorder and additional symptoms. On this basis, we distinguish:
- menorrhagia – regular bleeding occurring within the normal time frame, but exceeding 7 days, there is a large loss of blood (more than 80 ml),
- menometrorrhagia – is menstrual bleeding appearing irregularly, which lasts more than 7 days and/or involves blood loss of more than 80 ml,
- polymenorrhea – occur more frequently than every 21 days,
- oligomenorrhea – menstrual periods occur less frequently than every 35 days, this may be due to a prolonged follicular phase,
- amenorrhea – absence of menstruation for more than 6 months,
- metrorrhagia – irregular bleeding occurring between ovulatory cycles.
We can also distinguish ovulatory spotting, postmenopausal spotting, acute abnormal uterine bleeding and functional uterine bleeding. The incidence of these gynecological disorders varies according to the age of women. They affect ⅓ of women during the reproductive period, and the percentage increases to 50% after menopause. They are the cause of 25% of gynecological procedures.
What can be the causes of reproductive tract bleeding?
Changes in levels of sex hormones, especially estrogen and progesterone, can lead to irregular bleeding. So can other diseases of the reproductive system, such as uterine myomas, endometrial polyps, endometritis, ovarian cysts, infections of the reproductive tract or cancer. Other causes can include the following conditions:
- endometriosis in the uterine muscle (adenomyosis),
- pregnancy and associated conditions (miscarriage, ectopic pregnancy, placental detachment),
- endometrial proliferation,
- coagulation disorders (coagulopathies),
- hormonal and intrauterine contraception,
- inflammatory conditions,
- mechanical damage,
- adrenal insufficiency,
- liver diseases,
- pituitary adenomas,
- suppression of the hypothalamus,
- changes in the central nervous system.
At a younger age, functional uterine bleeding is most common, while at childbearing age, once pregnancy is ruled out, causes of bleeding include iatrogenic factors such as taking medications or herbal supplements or the presence of an IUD.
Stress and reproductive tract bleeding.
Stress affects a woman's body in a variety of ways. It turns out that it can be responsible for the delay or absence of menstruation. Prolonged or severe emotional tension disrupts the regularity of the menstrual cycle and intensifies the symptoms of premenstrual syndrome. In addition, it can be one of the triggers of bleeding between periods. This is due to increased levels of cortisol and prolactin in the blood. Prolactin, secreted by the pituitary gland, inhibits the action of estrogen and progesterone, which usually occurs in a breastfeeding situation. In such a situation, a woman may experience a periodic disappearance of menstruation.
Diagnosis of reproductive tract bleeding
Sudden bleeding from the genital tract is a reason for an urgent visit to the gynecologist. Diagnosis of these disorders can include a number of steps to determine the cause of the discomfort. The doctor takes a detailed medical history, asking about the history and history of menstruation, symptoms accompanying bleeding, use of medications (including contraception) and other possible factors affecting reproductive health. Gynecological examinations may include an examination of the genitals to look for possible abnormalities, such as cervical lesions, polyps or inflammatory changes. Determination of blood hormone levels is also usually recommended. In some cases, a genital ultrasound may be recommended to visualize the uterus, ovaries and other structures. Sometimes other imaging tests are also performed, such as a CT scan or diagnostic hysteroscopy. Cytological and histological evaluation of samples taken from the uterine cavity is also an important diagnostic step. Diagnosis of genital tract bleeding is a multi-step process that may require multiple tests depending on the individual patient's case. It is important to accurately assess the cause of the condition so that appropriate treatment can be implemented.
Sudden genital tract bleeding vs. pregnancy
Some cases of bleeding from the genital tract can be associated with pregnancy. One of these is implantation bleeding, which occurs when an embryo implanted in the endometrium. Nevertheless, not all women experience this phenomenon. However, such a symptom can also be a sign of ectopic pregnancy, which means that a fertilized egg cell is implanted outside the uterine cavity.
Treatment of reproductive tract bleeding.
Treatment of bleeding between cycles depends on the cause of the phenomenon. Sometimes it does not require medical intervention, especially when the bleeding is related to ovulation or minor damage to the mucous membrane during intercourse. In some cases, a doctor may recommend hormonal medications, nonsteroidal anti-inflammatory drugs or antibiotics to relieve symptoms. Management is largely determined by the severity of the bleeding.
However, in situations where bleeding between menstrual periods is caused by more serious conditions and conservative treatment does not work, more advanced measures are needed. In such cases, the doctor may recommend surgery to remove a cancerous lesion. Laparoscopic techniques are also used. Abnormal bleeding from the genital tract can be a symptom of a variety of diseases and pathological conditions in women. Their understanding, proper diagnosis and treatment are key to ensuring health and a good quality of life. Therefore, it is important that any abnormal bleeding be carefully evaluated by a physician to determine the appropriate treatment plan.
Conclusion
Abnormal bleeding is not just inconvenient—it can signal serious health issues. Understanding the difference between normal cycles and pathology, alongside key causes like hormonal shifts, stress, or medical conditions, is critical. Proper diagnosis and treatment ensure better health and life quality. Don't ignore symptoms like heavy, irregular, or unexpected bleeding. Seek timely medical attention, as early diagnosis leads to effective solutions. Your health depends on taking action when something feels off. Prioritize regular checkups and communicate openly with your doctor to protect your well-being.
