Many young women are given a small pouch to keep pads and other necessities, just in case of unexpected vaginal bleeding. As these young women grow older, the need for this pouch is less, as periods become regular and normal. Yet still these pouches are found in most adult women's bags and purses, even those with regular, like-clockwork, app-correlated 28-day cycles. This is because up to 30 per cent of women will experience some form of abnormal uterine bleeding (AUB) at some point in their lives, occuring at often inconvenient and embarrassing times. AUB refers not only to the regularity of bleeding, but also the amount and duration. Although it's undoubtedly one of the most common complaints we see in office, many women have misconceptions about what exactly constitutes a normal period. In fact some doctors still struggle with the definitions because the definitions keep changing.
What's a normal period?
This differs widely from woman to woman, so you really shouldn't judge your cycle based on what your friends and family tell you about theirs. Here are a few guidelines:
Cycle length – Calculated from the first day of your period to the first day of your next period, the average cycle length varies between 24 and 38 days. Even within this range, each woman's cycle length can vary up to seven days and still be considered normal (for women ages 18-45). That essentially means you can have a 25-day cycle one month, then a 31-day cycle the next, and nothing would be wrong with you.
Flow – Heaviness of flow is usually a more subjective assessment. If the flow is heavy enough to disrupt your social, work or school life, then it is deemed heavy. If you want to get technical, then I'd say 80mls or more of bleeding is abnormal. The duration of bleeding is usually less than eight days, and there is no minimum.
Bleeding in between your period can actually be a normal thing too. Around ovulation, some women note light spotting. This is usually nothing to worry about. You may also have similar light bleeding right before your period starts without any real concern most times.
Knowing this can now help you to know what's not normal. If your cycle is shorter than 24 or longer than 38 days, you should probably get it checked out. Similarly, if you bleed for more than eight days or the flow is interfering with your daily functioning, or just randomly bleeding between your cycles, then that's also AUB.
There is a long list of causes for AUB, which can be divided into two main groups for ease of discussion.
1) Things that are physically wrong with the womb. These include polyps, fibroids, adenomyosis, infection and cancer.
2) External problems that affect the womb. Here we see patients with hormonal imbalances, thyroid disease, generalised bleeding disorders and medications. In fact some of the medications that we use to treat AUB, in fact have AUB as a listed side effect!
What to do if you have AUB?
See a doctor. The above list is not even half of what could be wrong, and the treatments for some of the causes are somewhat specific.
Examination is required (yes, even if you are bleeding at the time). Blindly prescribing medication will miss the ones that have obvious problems like polyps, prolapsed fibroids or cancer. Pelvic imaging of some kind, whether ultrasound or MRI, is needed in most cases to reach a diagnosis. Laboratory tests are done to check for a variety of hormonal disturbances, infections and your blood count.
So please avoid self-treating with over the counter contraceptive pills or leftover medications that your girlfriend got from her gynaecologist. Oftentimes this clouds the picture and delays the diagnosis and treatment of the underlying problem. I know the problem is frustrating, but it's always better not to treat it blindly. Blind treatment often leads to constant restocking of the 'accident pouch'.
Dr Ryan Halsall is a consultant obstetrician gynaecologist who operates at ILAP Medical, 22 Windsor Avenue, Suite 2, Kingston 5. He can be contacted at email@example.com or 876-946-0353. Follow him on Instagram: @drhalsall
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