Treating excessive vaginal bleeding

In this week’s Health Capsule we take a closer look at vaginal bleeding. 
To give more information about the subject to our readers we spoke to Dr. Wasantha Jayalath who is a Specialist in Gynecology and Obstetrics and serves at the Teaching Hospital in Gampola.  

This condition can be described as vaginal bleeding which is excessive, unusual or irregular, compared to normal menstrual bleeding. Even a newly-born girl might bleed from the vagina, but this is rare. This is due to a sudden stoppage in maternal hormones acting on a baby girl’s uterus. This condition gradually subsides without treatment.   

If vaginal bleeding occurs in infants, it could be due to a tear or a leach bite or a foreign body inserted into the vaginal (by herself or by accident if it is a foreign body) passage. In such instances there usually is a smelly vaginal discharge after sometime.  

Before puberty (breast development, hair growth in groin and armpits) if there is vaginal bleeding, it is undoubtedly due to an injury or bite or some other’s blood or red-coloured stain that has come on the underwear. Without breast development and hair growth in the armpits and groin, the first menstruation or menarche is unlikely to occur.  

It is not uncommonto see menstruation being irregular after menarche. This is almost always due to hormonal irregularities. This condition usually subdues after maturity of the body at around age 20. In the case of troublesome menstruation, hormonal treatment can be stared for a few months.  It is important to suspect pregnancy-related causes in the case of irregular bleeding after marriage even if you are using contraception. Therefore a pregnancy test is a must before other medications or treatments.  

Hormonal contraceptives are also the cause of irregular menstrual bleeding. The Depo-Provera injection is well-known for this. Long cycles (cycles recurring after 6 weeks or more) or menstruation once in three-four months is a treatable condition and should be tested.   

Polyps in uterine cavity or cervix may cause unusual bleeding. After intercourse, if there is bleeding, cervical polyp should be excluded. When abnormal bleeding occurs after 40 years, endometrial malignancy (uterine cancer) should be excluded. But the commoner causes are hormonal irregularities, contraceptives, pregnancy-related problems and polyps. Uterine and cervical cancers are rare causes for this condition.  

But in the case of abnormal bleeding after menopause (cessation of menstruation) the possibility of a cancer is somewhat high. Therefore it is mandatory to take a sample of the inner layer of uterine cavity and examine that under a microscope. But the commonest cause for this condition in women of that age is estrogen deficiency. This must be treated using the estrogen hormone which reduces some other symptoms such as hot flushes (feeling hot flushing of skin frequently) poor sleep, pain during intercourse or loss of sexual desire, loss of memory and increased anger.