menses, am i bleeding?

bleeding,the cause of the irregular bleeding is not found. For these women the most likely reason is a change in hormonal activity. This is described as dysfunctional uterine bleeding.

This is the most common cause of abnormal vaginal bleeding during a woman's childbearing years. Up to 10% of women may experience excessive bleeding at one time or another. African American women tend to have more episodes.

When the complex hormonal process that creates your menstrual period loses coordination and the hormones oestrogen and progesterone are out of balance, your body overproduces uterine blood flow. Thus, you may experience excessive vaginal bleeding. This bleeding is related to irregularities of your menstrual cycle without any evidence of disease.

The diagnosis of dysfunctional uterine bleeding is a diagnosis of exclusion, which means that all other causes for the bleeding (including trauma, lesions, or diseases) have been looked for and determined not to be the cause of the bleeding.

Diagnosis methodsDiagnosing abnormal bleeding involves a number of tests. Your healthcare provider will take a careful medical history. You will be asked questions about the following issues and other general questions regarding your health:

* This episode of vaginal bleeding

* Your last known normal menstrual cycle

* Previous episodes of abnormal bleeding

* Currently pregnancy (if any)

* Previous pregnancies

* Outcomes of previous pregnancies

* Present sexual activity

* Use of any form of birth control

* Number of sexual partners

*Any medications, over-the-counter, or illicit drugs you are taking

The doctor will also perform a complete physical, including a thorough pelvic exam. The exam includes careful inspection of your external genitalia, urethra, and anal area.
The vaginal walls and cervix or birth canal are inspected for the presence of any lesions or retained foreign objects.Sometimes a tampon or other object is left in the vagina and can cause bleeding.

While the doctor is examining your vagina and cervix, the doctor may take cultures (fluid samples) to test for sexually transmitted diseases such as gonorrhea and chlamydia.
The doctor may also take cells from the cervix that wil be examined for cancer. This is a Pap smear.

It is also important for the doctor to place his or her hand ito your vagina and sometimes your rectum to detect the shape of your uterus and ovaries as well as to feel for any masses that may be present.
Tests that may be performed with abnormal uterine bleeding include the following:

* A pregnancy test needs to be done to make sure that pregnancy is not the cause of your bleeding.

* Blood wil be taken to see if you are anaemic (have low red blood cell counts) or have a low platelet count.

* A clotting series that includes a prothrombin time (PT) and an activated partial thromboplastin time (PTT) gives information about your ability to form clots in your body to stop bleeding. Abnormal vaginal bleeding may be the first sign that you may have a bleeding disorder.

*Your doctor may also order thyroid tests, which are blood tests that examine the thyroid gland (a gland in the neck responsible for many complex functions of the body).

* Further tests, such as an ultrasound scan of the uterus, may be recommended. This is a simple test in which gel is placed on the lower abdomen and a special scanner is moved through the gel. If necessary, a vaginal ultrasound may occasionally be performed, in which the scanner is placed inside the vagina instead of on the abdomen. In this way, clearer and more accurate views of the uterus can be obtained.

* A vaginal ultrasound to look at the lining of the womb can also detect endometrial hyperplasia (thickening of the lining of the womb), uterine fibroids and routinely check for ovarian cysts and other pelvic abnormalities.

* An endometrial biopsy may be performed to take tissue form your uterus. This is performed in the doctor's office and is a little more invasive than a Pap smear.

* A hysteroscopy may be indicated. This involves a long fine telescope, used to look at the lining of the uterus(the endometrium) from the inside, usually under general anaesthetic. It may be performed as a day case or it may involve an overnight stay in hospital. At the start of the procedure, the doctor dilates the cervix slightly, so that the telescope can be inserted through the cervixtowards the inside of the uterus. With this technique, it is possible to take a biopsy (remove tissue for examination) from specific areas of the lining of the uterus.
Treatment options Fortunately, most heavy bleeding can now be easily treated without major surgery.

*Medicines.Prostaglandin inhibitors and tranexamic acid are non-hormonal therapy that works on the clotting mechanisms in the lining of the uterus. Tablets are taken only on days when you have heavy bleeding. it may decrease heavy flow, but may lengthen the time of bleeding. Birth control pills may also decrease bleeding by almost a third. Most bleeding caused by hormone imbalance can be treated medically.

* Progesterone Intrauterine System(IUS)
The Mirena progesterone IUS may decrease bleebing. It steadily releases a tiny amount of progestogen within the cavity of the uterus. This keeps the lining of the uterus(endometrium) thin and inactive rather than increasing in thickness as it normally would in the build-up to ovulation. Menstruation normally occurs when the lining of the uterus falls away, in this case, because the lining of the uterus has not increased in thickness the menstrual bleeding is reduced.
Treating uterine problems

* Dilatation and curettage (D&C)The cervix is dilated and the endometrium gently scraped away. If abnormal bleeding is caused by polyps, often, removing them with the curette will solve the problem.

* Endometrial ablationSometimes an endometrial ablation is done at the same time to further reduce or eliminate bleeding. Endometrial ablation is a day surgery procedure that will usually eliminate or greatly decrease menstrual bleeding.
Since an endometrial ablation destroys the lining of the uterus, endometrial ablation is not for anyone, especially those who desire to keep her fertility. Women who have a malignancy or pre-malignant condition of the uterus are not candidates for ablation. Women who have severe pelvic pain, unless the pain is coming from an intracavitary myoma, may be better served by alternative treatments. Although pregnancy is unlikely after ablation, serious complications could arise. It is essential for a woman to use reliable contraception after an endometrial ablation.
HysterectomyOne of the reasons women get hysterectomies is to control heavy menstrual bleeding. This is the only procedure that guarantees permanent elimination of any bleeding.
Hysterectomy is the removal of the uterus. The operation can be done in three ways:* Abdominal hysterectomy is when the uterus is removed through a cut in the abdomen

* Vaginal hysterectomy is when the uterus is removed through the opening of the vagina

* Laparoscopically assisted vaginal hysterectomy also involves removing the uterus through the vagina but there are small cuts made in the abdomen to allow the surgeon to do part of the operation. The aim of this operation is to reduce recovery time and discomfort after operation.
The type of hysterectomy a woman has is dependent on a range of factors, including the nature of her problem and her medical history. Any decision to undergo hysterectomy, other than pre-cancer or cancer changes needs to be carefully discussed. Sometimes it is wise to seek a second opinion and to review options for other treatments.
What should you do if you experience irregular vaginal bleeding?See your health care provider for any abnormal vaginal bleeding. It is not always necessary to go to a hospital emergency department for this problem. An office visit to a gynaecologist (a doctor who specialises in female reproductive organs) is usually sufficient if you are bleeding but do not have any other symptoms.
Be certain to record when the bleeding occurs during the month. Also, try to determine if the bleeding is vaginal or anal. Don't be frightened-most irregular vaginal bleeding has a benign cause. If you're having heavy vaginal bleeding-saturating a pad an hour for more than a couple of hours-seek prompt medical attention.
If you're taking birth control pills or are on hormone therapy, consult your doctor and follow the instructions he or she gives you. This may be as simple as taking more pills, but you may need to change medicines completely.
If you are having abnormal vaginal bleeding with other symptoms, such as lightheadedness, severe abdominal pain, or fevers, or if you're pregnant and experience vaginal bleeding, you should be evaluated as soon as possible. This includes being seen in an emergency department.
What is the outcome of having abnormal vaginal bleeding?The outcome depends on the cause of the problem, but abnormal vaginal bleeding rarely results from a serious condition and can usually be treated successfully.

* This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public.
The members of the panel include: Datuk prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Assoc Prof Khoo Ee Ming, primary care physician.

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