Obstetric & Gynaecology Malaysia


When is uterine bleeding is abnormal?

Heavy bleeding that soak through a pad every 1 or 2 hours during menses or  period

Heavy bleeding that pass large lumps of blood clots especially bigger than 2.5cm wide

Bleeding that lasts more than normal or continue on more than 8 days

Bleeding or spotting in between periods

Bleeding or spotting after sex

Bleeding after menopause

Menstrual cycles that are shorter than 24 days

Menstrual cycles that are longer than 42 days

Irregular periods in which cycle length varies by more than 8 days.

Pelvic pain and bad cramps in your lower belly before or while you are bleeding.

In a normal menstrual cycle, the levels of the hormones estrogen and progesterone increase and decrease in a regular pattern. Ovulation occurs in the middle of the cycle. If a woman does not get pregnant, a period starts about 2 weeks later.

What causes abnormal uterine bleeding?

There are many different causes depending on the age of the women.

  • Problems with ovulation, the ovaries are not releasing the egg regularly, common after a woman attain her menarche       (9-16 y0), perimenopausal (from 40 years old) and seen in polycystic ovarian syndrome (PCOS).
  • Growths in the uterus eg fibroid or polyp, which are mostly non cancerous
  • Adenomyoma, condition of the endometrium grows into the wall of uterus
  • Side effects of medication eg hormonal pill, birth control pills, blood thinners or use of intrauterine device (IUCD)
  • Problem with thyroid gland that makes hormones to regulate metabolism.
  • Endometritis, infection in the uterus from bacterial vaginosis due to poor immune system in diabetes or chronic stress.
  • Ectopic pregnancy
  • Miscarriage
  • Bleeding disorder that prevents your blood from clotting eg Von Willebrand disease
  • Endometrial hyperplasia, abnormal thickening of the endometrium due to excess estrogen hormone without enough     progesterone hormone
  • Atrophic endometrium in post menopausal women where the endometrial lining become too thin and dry that     spontaneously cracked and bleed.
  • Cancer of the uterus, cervix of ovaries

Signs of being low in iron include:

  • Feeling weak, very tired
  • Having headaches
  • Having trouble breathing when you exercise=Shortness of breath on exertion
  • Feeling your heart beat too fast when you exercise=Palpitation

Here are the most common tests doctors use to find the cause of heavy periods:

●Blood tests – Blood tests can check if you are pregnant. They can also check for hormonal changes, a bleeding disorder, low iron levels, or other problems.

●Pelvic ultrasound – This test uses sound waves to look for fibroid in the uterus, cyst in the ovaries or  other growths.

●Endometrial biopsy – For this test, the doctor will take a sample of tissue from inside your uterus in the clinic. The sample can be viewed under a microscope to look for problems.

●Hysteroscopy – For this test, the doctor will use a small instrument to look inside your uterus.

Treatment depends on what is causing the heavy periods and whether you want to get pregnant soon. You might not need treatment. If you do, treatments might include:

●Birth control methods that contain hormones – These make your period lighter or stop your periods completely. Eg Pills, Skin patches, Shots that you get every 3 months, An intrauterine device (IUD), that your doctor inserts into your uterus

●Medicines that thicken blood and slow bleeding, tranexamic acid (Transamin)

●Medicines that reduce inflammation, such as ibuprofen or mefenamic acid (Ponstan)

●Medicines that contain a hormone called "progestin" – These are taken for a week or so every few months.

●Medicines that make the ovaries stop working for a short time

If you have fibroids, or if medicines haven't helped with your heavy periods, your doctor might suggest surgery. Your options will depend on whether or not you might want to get pregnant in the future. They might include:

●The removal of fibroids or other growths

●Endometrial ablation – This is a procedure that causes scarring in the inner lining of the uterus.

●Uterine artery embolization – This is a procedure to block the blood vessels that supply blood to the uterus.

●Hysterectomy – This is surgery to remove the uterus. After a hysterectomy, you will no longer have periods at all.