Vaginal Bleeding (cont.)
What conditions cause abnormal vaginal bleeding in women who are NOT ovulating regularly or vaginal bleeding after menopause?
Many conditions can interfere with the proper function of female hormones
that are necessary for ovulation. For example, many conditions or circumstances
may cause oligomenorrhea (reduction in the number of menstrual periods and/or
amount of flow than usual) such as:
- If a woman has chronic medical illnesses or is under significant medical
or emotional stress, can begin to have a loss of her menstrual periods.
- Malfunction of a particular part of the brain, called the hypothalamus, can cause
oligomenorrhea.
- Anorexia nervosa is an eating disorder associated with excessive thinness that
causes many serious medical consequences as well as oligomenorrhea or amenorrhea
(the absence of menstrual periods).
- Polycystic ovarian syndrome
(PCO or POS) is a hormonal problem that causes women to have a variety of
symptoms that include irregular or no menstrual periods, acne, obesity,
infertility, and excessive hair growth; that are detectable with blood
tests.
The complete loss of ovulation is referred to as
anovulation. Since ovulation allows the body to maintain an adequate supply of
progesterone, anovulation is a condition in which a woman's hormonal balance is tipped toward too much estrogen
and not enough progesterone. The excess estrogen stimulates the growth of the
lining of the uterus. The result is that the lining of the uterus becomes too
thick, which eventually leads to an increased risk of uterine pre-cancer or
uterine cancer over
many years. In order to replace progesterone and establish a proper hormonal
balance, doctors will prescribe either progesterone to be taken at regular
intervals, or an oral contraceptive that contains progesterone. Such treatment
dramatically decreases the risk of uterine cancer in women who do not
ovulate. Because uterine cancer results from many years of anovulation, any
woman with prolonged anovulation needs to be treated to avoid developing uterine
cancer.
Women who are postmenopausal
(those who have not had a menstrual period for 12 consecutive months or more) should
not experience vaginal bleeding. Any vaginal bleeding is considered abnormal in
postmenopausal women. Women who are taking combined estrogen and progesterone
hormone therapy (HRT or HT) may experience some light, irregular vaginal
bleeding during the first six months of treatment. Likewise, postmenopausal
women who are taking a cyclic hormone regimen (oral estrogen and a progestin for 10-12 days per month) may experience
some vaginal bleeding that is similar to a menstrual period for a few days each
month.
Postmenopausal women who experience heavy or prolonged vaginal bleeding while
on hormone therapy should always see a doctor to rule out more serious causes of vaginal
bleeding. Less frequent but serious causes of vaginal bleeding in postmenopausal
women include endometrial cancer or hyperplasia (overgrowth of the lining
tissues of the uterus, which can be precancerous in some cases).
Next: What causes abnormal vaginal bleeding during or after
sexual intercourse? »
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