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Knowing your body is the first step in achieving optimal health. For women of reproductive age, it is important to be alert and pay attention to signs of changing patterns such as those commonly observed with menses.

When a young girl reaches puberty, her body starts to undergo a series of physiological changes that result in the development of secondary sexual characteristics. Similarly, menstruation starts with the onset of the first period (menarche). In the first year or two, the body is progressively adapting to that change, and as a result periods might be irregular and inconsistent. However, past that stage, every woman should have a consistent menstrual cycle where menses are expected at a specific interval of time, and once every month. Any deviation from that norm (where menses come more than once per month) is considered abnormal.

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Causes of abnormal uterine bleeding

There are several factors that come in place in the etiology of abnormal uterine bleeding.

Uterine pathologies

Uterine fibroids are benign tumors that found in the wall of the uterus. Their growth and development is influenced by estrogen, which is why they are more common in women of reproductive age. They are classified based on the layer of the uterus from which they develop. If they grow within the myometrium, they are called intramural. They can also be submucosal (develop under the uterine mucosa), subserosal (from the outermost layer of the uterus) or pedunculated(develop at the surface of the uterus). Depending on how big they are, they can be palpated from the outside.

Generally, women who have uterine fibroids experience heavier than normal bleeding, significantly longer periods (going up to 7 – 10 days), abdominal bloating and cramping during periods.

The diagnosis of uterine fibroids is confirmed with an abdominal ultrasound, and the treatment options (from medical to surgical) depending on each woman.

Endometriosis is another medical condition that could cause bleeding outside of periods. It is medically defined as the presence of endometrial tissue outside of the uterine cavity. Some common locations are the ovaries, the rectum, or the pouch of Douglas (space between the large intestine and the uterus). There are several theories that attempted to explain the presence of endometrial tissue in those sites. Just like in the case of uterine fibroids, women suffering from endometriosis present significantly heavier and longer periods, as well as moderate to severe abdominal cramping. Additionally, they might report bleeding and pain with defecation (if the endometrial tissue is present in the rectum). Treatment options include hormonal control, pain medications (as the pain can be excruciating at time) and surgical management.

Polycystic ovarian syndrome

Also commonly known as PCOS, polycystic ovarian syndrome is an endocrine abnormality in which a woman presents with several mature follicles in the ovaries but yet is unable to ovulate. The pathophysiology of this disease is multifactorial, and only few aspects of this disorder have been understood up to today.  The most common complication of PCOS is infertily, which is why this diagnosis can be life changing in a woman in her reproductive age. Symptoms of this condition vary from moderate to severe, according to the individual. They include lack of ovulation, absence of periods or irregular periods (lighter bleeding, periods lasting less than 5 days, skipped periods, etc.) acne, involuntary weight gain and even trouble losing weight. Occasionally, women may experience hair thinning on the scalp. The diagnosis of this condition is very complex and requires a series of medical investigations.

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