Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
What conditions cause abnormal vaginal bleeding in women who are ovulating regularly?
Abnormal vaginal bleeding in women who are ovulating regularly, most commonly
involve excessive, frequent, irregular, or decreased bleeding. Some of the
common conditions that produce each of these symptoms are discussed below.
Excessively heavy menstrual bleeding (menorrhagia)
Excessively heavy menstrual bleeding, called menorrhagia, is menstrual
bleeding of greater than 5 tablespoons per month. This condition occurs in about
10% of women. The most common pattern of menorrhagia is excessive bleeding that
occurs in regular menstrual cycles and with normal ovulation.
There are several important reasons that menorrhagia
should be evaluated by a doctor. First, menorrhagia can cause a woman substantial emotional distress
and physical symptoms, such as severe cramping
.
Second, the blood loss can be so severe that it causes a dangerously lowered
blood count (anemia), which can lead
to medical complications and symptoms such as dizziness and fainting. Third,
there can be dangerous causes of menorrhagia that require more urgent treatment.
Benign (noncancerous) causes of menorrhagia include:
blood clotting disorders such as inherited bleeding disorders, and
certain medications, especially those that interfere with blood
clotting.
Though not common, menorrhagia can be a sign of endometrial cancer. A potentially
precancerous condition known as endometrial hyperplasia can also result in
abnormal vaginal bleeding. This
situation is more frequent in women who are over the age of 40.
Although there are many causes of menorrhagia, in most
women, the specific cause of menorrhagia is not found even after a full medical
evaluation. These women are said to have dysfunctional uterine bleeding. Although no specific
cause of the abnormal vaginal bleeding is found in women with dysfunctional
uterine bleeding, there are treatments available to reduce the severity of the
condition.
Irregular vaginal bleeding; menstrual periods that are too frequent
(polymenorrhea)
Menstrual periods that are abnormally frequent
(polymenorrhea) can be caused by certain sexually transmitted diseases
(STDs) (such as chlamydia or gonorrhea) that cause
inflammation in the uterus. This condition is called pelvic inflammatory disease.
Endometriosis is a condition of unknown
cause that can lead to pelvic pain and polymenorrhea. Sometimes, the cause of polymenorrhea is unclear, in
which case the woman is said to have dysfunctional uterine bleeding.
Menstrual periods at irregular intervals (metrorrhagia)
Irregular menstrual periods (metrorrhagia) can be due to
benign growths in the cervix, such as cervical polyps. The cause of these
growths is usually not known. Metrorrhagia can also be caused by infections of
the uterus (endometritis) and use of birth control pills
(oral contraceptives). Sometimes
after an evaluation, a woman's doctor might determine that her metrorrhagia does
not have an identifiable cause and that further evaluation is not necessary at
that time.
Perimenopause is the time period approaching the
menopausal transition. It is
often characterized by irregular menstrual cycles, including menstrual periods
at irregular intervals and variations in the amount of blood flow. Menstrual
irregularities may precede the onset of true menopause (defined as the absence
of periods for one year) by several years.
Decreased amount or duration of menstrual flow (hypomenorrhea)
An overactive thyroid function (hyperthyroidism) or
certain kidney diseases can both cause hypomenorrhea. Oral contraceptive pills
can also cause hypomenorrhea. It is important for women to know that lighter,
shorter, or even absent menstrual periods as a result of taking oral
contraceptive pills does not indicate that the contraceptive effect of the oral contraceptive pills is
inadequate. In fact, many women appreciate this "side effect" of oral contraceptives.
Bleeding between menstrual periods (intermenstrual bleeding)
Women who are ovulating normally can experience light
bleeding (sometimes referred to as "spotting") between menstrual periods.
Hormonal birth control methods (oral contraceptive pills or patches) as well as
IUD use for contraception may sometimes lead to light bleeding between periods.
Psychological stress, certain medications such as anticoagulant drugs, and
fluctuations in hormone levels may all be causes of light bleeding between
periods. Other conditions that cause abnormal menstrual bleeding, or bleeding in
women who are not ovulating regularly (see below) can also be the cause of
intermenstrual bleeding.
Yeast vaginitis is a yeast infection of the vagina. Symptoms include itching, burning, soreness, pain during intercourse and urination, and vaginal discharge. Yeast infections can be treated with over-the-counter and prescription medications.
There are many symptoms involved in the 1st, 2nd and 3rd trimesters of pregnancy. The first early pregnancy symptom is typically a missed period, but others include breast swelling and tenderness, nausea and sometimes vomiting, fatigue and bloating. Second trimester symptoms include backache, weight gain, itching, and possible stretch marks. Third trimester symptoms are additional weight gain, heartburn, hemorrhoids, swelling of the ankles, fingers, and face, breast tenderness, and trouble sleeping. Read more to learn about recommended procedures and tests for each stage of a healthy pregnancy.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased.
Blood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
Endometriosis is the growth of cells similar to those that form the inside of the uterus, but in a location outside of the uterus. Endometriosis implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They can also be found in the vagina, cervix, and bladder. Treatment of endometriosis can be with medication or surgery.
An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus. The majority of ectopic pregnancies occur in the Fallopian tube. Symptoms include abdominal pain, amenorrhea, and vaginal bleeding. Treatment options include observation, medication, or surgery.
Sexually transmitted diseases, or STDs,
are infections that are transmitted during any type of sexual exposure,
including intercourse (vaginal or anal), oral sex, and the sharing of sexual
devices, such as vibrators. Women can contract all of the STDs, but may have no symptoms, or have different symptoms than men do.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Though uterine cancer's cause is unknown, there are many factors that will put a woman at risk, including: over age 50, endometrial hyperplasia, using hormone replacement therapy, obesity, using tamoxifen, being Caucasian, having colorectal cancer. Symptoms of cancer of the uterus (endometrial cancer) include abnormal vaginal bleeding, painful urination, painful intercourse, and pelvic pain. Treatment depends on staging and may include radiation therapy or hormone therapy.
Hyperthyroidism is an excess of thyroid hormone resulting from an overactive thyroid gland. Symptoms can include increased heart rate, weight
loss, depression, and cognitive slowing. Treatment is by medication, the use of
radioactive iodine, thyroid surgery, or reducing the dose of thyroid hormone.
Cervical cancer is cancer of the entrance to the womb (uterus). Regular pelvic exams and Pap testing can detect precancerous changes in the cervix. Precancerous changes in the cervix may be treated with cryosurgery, cauterization, or laser surgery. The most common symptom of cancer of the cervix is abnormal bleeding.
Menopause is the time in a woman's life when menstrual periods permanently stop, also called the “change of life." Menopause symptoms include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies, and should be discussed with your physician.
Chlamydia, a type of bacteria that causes an infection, is spread through sexual contact. Most of the time, women with chlamydia have no symptoms. Antibiotics are an effective treatment for chlamydia.
Anorexia is an eating disorder characterized by markedly reduced appetite or total aversion to food. Anorexia is a serious psychological disorder and is a condition that goes well beyond out-of-control dieting. With anorexia, the drive to become thinner is actually secondary to concerns about control and/or fears relating to one's body. There are psychological and behavioral symptoms as well as physical symptoms of anorexia including: depression, social withdrawal, fatigue, food obsession, heart and gastrointestinal complications, kidney function, flaky skin, brittle nails, and tooth loss (this list is not exhaustive).
A miscarriage is any pregnancy that ends spontaneously before the fetus can survive. Miscarriage usually occurs before the 13th week of pregnancy. The cause of a miscarriage cannot always be determined. The most common causes of a miscarriage in the first trimester are collagen vascular disease (lupus), hormonal problems, diabetes, chromosomal abnormalities, and congenital abnormalities of the uterus.
Pelvic inflammatory disease (PID) is the most common and serious complication of sexually transmitted diseases (STDs), aside from AIDS, among women. The signs and symptoms of pelvic inflammatory disease include: fever, vaginal discharge with a foul odor, abdominal pain, including pain during intercourse, and irregular vaginal bleeding. Pelvic inflammatory disease can scar the Fallopian tubes, ovaries, and related structures and lead to ectopic pregnancies, infertility, chronic pelvic pain, and other serious consequences. Pelvic inflammatory disease treatment includes several types of antibiotics.
Uterine fibroids are benign tumors that originate in the uterus and are usually round or semi-round in shape. The most common symptom of a uterine fibroid is abnormal vaginal bleeding. Other symptoms include pressure, pelvic pain, pressure on the bladder, or pain during a bowel movement. Treatment options vary from surgery to medication.
Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms including irregular or no menstrual periods, acne, obesity, and excess hair growth. Treatment of PCOS depends partially on the woman's stage of life and the symptoms of PCOS.
Internal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
Dyspepsia (indigestion) is a functional disease in which the gastrointestinal organs, primarily the stomach and first part of the small intestine, function abnormally. It is a chronic disease in which the symptoms fluctuate infrequency and intensity. Symptoms of dyspepsia include upper abdominal pain, belching, nausea, vomiting, abdominal bloating, early satiety, and abdominal distention (swelling). These symptoms are most often provoked by eating.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Gonorrhea is a bacterial infection transmitted during sexual contact. In women, symptoms include a yellow vaginal discharge, burning or frequent urination, and redness, swelling, burning and itching of the vaginal area. Gonorrhea can be treated with injectable (penicillin) or oral medications.
Amenorrhea is a condition in which there is an absense of menstrual periods in a woman. There are two types of amenorrhea, 1) primary and 2) secondary. Treatment of amenorrhea depends on the type (primary or secondary). In prmiray, surgery may be an option and in secondary amenorrhea medication or lifestyle changes may be treatment options.
Toxic shock syndrome (TSS) is a condition caused by toxins formed by Staphylococcus aureus or group A Streptococcus bacteria. Signs and symptoms include fever, low blood pressure, rash, diarrhea, nausea, and vomiting. Left untreated, the patient will experience confusion, dizziness, headaches, seizures, and multiorgan failure. Treatment involves intravenous fluids and antibiotics, oxygen administration, surgery to drain the source of infection, and removal of tampons, nasal packings, or other sources of infection.
Prolactinoma is an adenoma (benign tumor) of the pituitary gland. Causes of many prolactinomas are unknown. Symptoms in women include changes in menstruation and infertility, decreased libido, or painful intercourse due to vaginal dryness. The most common symptom in men is impotence (erectile dysfunction). Treatment of prolactinomas are medication or surgery.
Graves' disease is an autoimmune disease that affects the thyroid. Some of the symptoms of Graves' disease include hand tremors, rapid heartbeat, trouble sleeping, enlarged thyroid, thinning of the skin or fine brittle hair. Causes of Graves' disease are thought to be multifactorial such as genes, gender, stress, and infection. Treatment for Graves' disease is generally medication.
Premenstrual dysphoric disorder (PMDD) is considered to be a severe form of premenstrual syndrome (PMS). PMDD has also been referred to as late luteal phase dysphoric disorder. The cause of PMDD is unknown. Some of the common symptoms of PMDD (not an inclusive list) include: mood swings, bloating, fatigue, headache, irritability, headache, breast tenderness, acne, hot flashes and more. Treatment for PMDD is with medication to treat the symptoms of PMDD.
Menstruation (menstrual cycle) is also referred to as a "period." When a woman menstruates, the lining of the uterus is shed. This shedding of the uterine linking is the menstrual blood flow. The average menstrual cycle is 28 days. There can be problems with a woman's period, including heavy bleeding, pain, or skipped periods. Causes of these problems may be amenorrhea (lack fo a period), menstrual cramps (dysmenorrhea), or abnormal vaginal or uterine bleeding. There are a variety of situations in which a girl or woman should see a doctor about her menstrual cycle.
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