Abnormal Bleeding

Bleeding that’s not part of your regular period or is longer, heavier, or more painful than normal can be a sign of a medical condition. It can also be a sign that you are in perimenopause.

Bleeding after sex, in between menses, or when you’re postmenopausal is especially worrisome. Some conditions that cause abnormal bleeding include:

• Noncancerous growths, such as fibroids or polyps
• Adenomyosis and endometriosis
• Hormonal imbalances, including polycystic ovary syndrome
• Overactive or underactive thyroid
• Infections, including pelvic inflammatory disease
• Cancer

Rarely, sexual abuse or a forgotten object, such as a tampon, might cause your bleeding. Sometimes an underlying disease may contribute to your abnormal bleeding.

When you're bleeding abnormally, Dr. Epstein first takes a detailed medical history, since the pattern of your bleeding can be important. She then gives you a physical examination, including a pelvic exam. Other tests she may perform include:

• Pap smear to check for cervical cancer
• Pregnancy test
• Blood tests to check iron, hormones, and thyroid
• Ultrasound to check your reproductive organs
• Endometrial biopsy to check for uterine cancer

The endometrium is the lining of your uterus that becomes flooded with blood right before your period. While you recline on the exam table with your feet in stirrups, Dr. Epstein takes a sample of your endometrium and sends it to a laboratory.

When the results come back, you meet with Dr. Epstein to discuss whether or not abnormal cells were detected. She gives you her diagnosis, makes treatment recommendations if necessary, and answers any questions you may have.

Dr. Epstein controls your bleeding based on her diagnosis of your condition. Treatments may include:

• Surgery to remove abnormal growths
• Low-dose estrogen or progestin to regulate hormones
• Antibiotics to eliminate infections
• Dilatation and Curettage and/or Medications to alleviate excessive bleeding
• Uterine Artery Embolization
• Endometrial Ablation
• Hysterectomy

If your vaginal bleeding is heavy, painful, or abnormal, contact Dr. Epstein right away: Call her caring team or book an appointment online for a consultation.