Monique Rainford

Abnormal vaginal bleeding can be frightening for women at any age and the perimenopausal period (the years around the menopause) is no exception. Although cancers of the female organs can be a cause of abnormal uterine bleeding, the vast majority of cases are due to non-cancerous reasons.

A normal menstrual cycle occurs between 21 and 35 days. The most frequent interval between periods is 28 days although only about 15 per cent of women have a 28 day cycle. A normal period lasts up to seven days. Therefore, if a woman has menses more often than every 22 days or less often than every 35 days or if she bleeds more than seven days she has abnormal uterine bleeding. It is also abnormal if her periods are very heavy, she has bleeding between her normal periods or if she bleeds irregularly, that is, if she has more than a four-day variation in her cycle length.

Uterine fibroids

Causes of abnormal uterine bleeding in the perimenopausal period include uterine fibroids or polyps, use of medications such as oral or injectable birth control, tranquillisers, pregnancy, thyroid problems, infection, and cancers of the female reproductive organs. If none of these conditions are identified and all other possible causes are excluded, she is diagnosed with dysfunctional uterine bleeding. This may occur with anovulatory bleeding where the woman does not ovulate (or produce an egg every month) or ovulatory bleeding where she does produce an egg monthly.

Uterine fibroids are non-cancerous growths of the uterus and are very common in Jamaican women. They are diagnosed more frequently when a women gets older (the perimenopausal years). They can be diagnosed by an examination in the physician's office and often an ultrasound is ordered for confirmation. Bleeding problems with fibroids can sometimes be treated with medication. However, if medication does not work or is not a good choice for the woman, she may need an operation to remove either the fibroids only or sometimes her entire uterus.

Cevical cancer

Cancers of the female reproductive organs such as the cervix (the neck of the womb) and the uterus are not the most common cause of abnormal bleeding in the perimenopausal years but is the most important. She must see her physician and may undergo certain tests such as a pap smear and/or a sampling of the lining of her uterus called an endometrial biopsy. It is very important that she does the necessary tests and return for her follow-up visits.

Dysfunctional uterine bleeding is the most common cause of heavy menses. Treatment of this condition includes non-steroidal anti-inflammatory drugs, the oral birth control pill, oral progestins and the levonorgestrel-releasing intrauterine system (sold in Jamaica as Mirena). All these treatments have been proven to reduce the menstrual bleeding and are an option for women who do not desire an operation. Women on the oral medications may take it daily or for certain days of the month. The mirena intrauterine system is a medication that is inserted in the womb and can remain for five years. It is also a method of contraception.

A woman with abnormal uterine bleeding can be reassured that there are many other causes besides cancer for her problem. However, she should get prompt attention and work with her physician to identify a cause and receive appropriate treatment.

Dr. Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.