When Should I Be Concerned About Irregular Menstrual Bleeding?

Irregular menstrual bleeding may be disconcerting, but it doesn’t always mean there’s something seriously wrong. 

Board-certified OB/GYN Dr. Hany H Ahmed sees all manner of irregular bleeding at his practice in Houston, Texas, diagnosing and treating a wide range of gynecological conditions. Here’s when you needn’t be concerned about irregular menstrual bleeding and when you should.

The menstrual cycle

Menstrual cycles are regular episodes of bleeding from the vagina that occur when your uterus doesn’t become impregnated with a fertilized egg and sheds its lining. A normal cycle happens every 24-38 days, with bleeding lasting no more than eight days.

Irregular bleeding occurs when you:

• Bleed between periods
• Bleed after sex
• Have heavy menstrual bleeding
• Bleed for more than eight days
• Bleed after menopause
• Have a menstrual cycle shorter than 24 days or longer than 38 days

What’s important in all these cases is the underlying cause of the irregularity; some are just minor problems, while others may be more serious. That’s why it’s important to see Dr. Ahmed whenever you experience any of these symptoms.

What causes irregular bleeding?

Common causes of irregular bleeding include:

Ectopic pregnancy

An ectopic pregnancy is when a fertilized egg develops outside the uterus. In 90% of cases, it occurs in a fallopian tube. The growing egg causes the tube to rupture from its size, which can lead to major internal bleeding. It’s a life-threatening emergency requiring immediate surgery.

Miscarriage

A miscarriage (or early pregnancy loss) is when you lose the fetus before 20 weeks. For women who know they’re pregnant, some 10%-20% of pregnancies end in miscarriage. And 80% of those happen in the first trimester — before the 12th week of pregnancy. 

Miscarriage in the second trimester (13-19 weeks) occurs in 1%-5% of pregnancies. Pregnancy loss after 20 weeks is termed a stillbirth.

Miscarriage is common and may affect more than 30% of all pregnancies. Many end before the woman even knows she’s pregnant. Miscarriages don’t necessarily affect fertility; most women who miscarry have a healthy pregnancy later on.

Fibroids

Fibroids are growths of muscle and other tissues that develop in or on the uterus wall. They’re the most common noncancerous tumors in women, but they can cause pain and bleeding and therefore require treatment.

Polyps

Uterine polyps are growths that attach by a stalk to the inner wall of the uterus. Also known as endometrial polyps, they form when cells in the lining of the uterus (endometrium) overgrow. Though usually benign, polyps can be cancerous or turn into cancer (precancerous polyps).

A uterine polyp ranges from a few millimeters to several centimeters, and you can have one or many. They usually remain in the uterus but can slip through the cervix (uterine opening) into the vagina. They’re most common in women going through or who’ve completed menopause.

Uterine polyps can lead to irregular menstrual bleeding, heavy menstrual flow, bleeding between periods, and bleeding after menopause.

Endometriosis

Endometriosis is a typically painful condition in which tissue similar to the inner lining of the uterus grows outside the uterus. It often affects the ovaries, fallopian tubes, and the tissue lining the pelvis. Rarely, endometrial growths may develop beyond the area the pelvic organs occupy.

Endometriosis tissue acts as the uterine lining would — every month, it thickens, breaks down, and bleeds during menstruation. However, it has no exit route from the body, and the surrounding tissue may become irritated and scarred.

When endometriosis involves the ovaries, cysts may form along with scar tissue. Bands of fibrous tissue (adhesions) may form, causing pelvic tissues and organs to stick to each other.

Common symptoms include painful periods, including pain in the lower back and stomach; pain during sex; pain with urination or bowel movements, often before or during your period; and excessive bleeding, either heavy flow during your period or bleeding between periods.

You may also experience irregular bleeding as a side effect of some forms of contraception, such as an intrauterine device (IUD), but it’s not a serious condition.

Are you having irregular menstrual bleeding? Visit the office of Dr. Hany H Ahmed to determine the root cause and get appropriate treatment. To request an appointment, call or click today.