Toward Optimal Health: The Experts Discuss Abnormal Uterine Bleeding

Jodi R. Godfrey, M.S., R.D.

In This Article

What makes a uterus prone to bleeding?

Dr. Bradley: Abnormalities of menstruation are quite common -- so much so that about 25%-30% of office visits to gynecologists are for evaluation and treatment of abnormal bleeding. Many young women have irregular periods for normal reasons, and it is not unusual for women to experience breakthrough bleeding at mid-cycle. Often, gentle reassurance is what the patient needs most.

Bleeding that is considered abnormal may be caused by structural, functional, or hormonal irregularities or certain medications. Generally, conditions that may relate to abnormal bleeding include early pregnancy, infection, the presence of foreign growths or objects, hormonal imbalance, cigarette smoking, and medications. The age of the patient can provide the best indicator of likely problems.

Dr. Schrager: An understanding of the normal menstrual cycle provides a critical guide for proper assessment of irregular uterine bleeding. The intervals of the menstrual cycle, the duration of flow, and the volume of flow remain relatively constant during a woman's reproductive years. The cause of dysfunctional bleeding is usually related to one of three hormone imbalances: estrogen breakthrough, estrogen withdrawal, and progesterone breakthrough. Estrogen breakthrough bleeding occurs when excess estrogen causes the endometrium to grow in an undifferentiated manner. Estrogen withdrawal bleeding occurs with a sudden decrease in estrogen levels, such as occurs following bilateral oophorectomy, cessation of exogenous estrogen therapy, or just before ovulation in the normal menstrual cycle. Estrogen withdrawal bleeding is usually self-limited and tends not to recur if estrogen levels remain low. Progesterone breakthrough bleeding occurs when the progesterone/estrogen ratio is high, leading to an atrophic and ulcerated endometrium because of a lack of estrogen, resulting in frequent, irregular bleeding. When a change in hormone regulation occurs, dysfunctional bleeding may follow.


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