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Abnormal bleeding from the uterus in women of reproductive age includes an increased frequency of bleeding, increased amount of blood, or prolonged duration of periods. This bleeding can be ovulatory, anovulatory, or anatomical. Any uterine bleeding appearing after menopause is qualified as abnormal.

There are several possible causes of abnormal uterine bleeding, but still, the actual cause remains unknown in about 40 percent of women, even after detailed examination.

Ovulatory Bleeding

Bleeding that occurs around the middle of the menstrual cycle is most likely ovulatory bleeding. It is stimulated by the quickly changed hormonal balance during ovulation which includes a rise in progesterone levels, while estrogen concentration is decreased. This bleeding is usually light spotting and lasts for several hours or rarely two days. It is usually in the form of brownish discharge. Treatment of ovulatory bleeding is usually not necessary unless if it is extensive and causes great discomfort.

In those rare cases, estrogen replacement therapy can be used for several days.

Anovulatory Bleeding

An anovulatory cycle is a type of menstrual cycle in which there is no ovulation (an oocyte is not being released). Although anovulation is completely asymptomatic in some women, who continue to have normal periods, 40 percent of women experience irregular and/or light bleeding, and 20 percent have absence of periods (amenorrhea). Anovulatory cycles are very common in young women during the early reproductive period and are one of the most common causes of infertility among older women.

Ovulation can be stimulated using hormone replacement therapy with great success rates.

Anatomical Bleeding

Anatomical bleeding is caused by a morphological anomaly or pathological formation present in the uterus. Uterine polyps are benign tumors of endometrium (inner layer of the uterus). Their most pronounced symptom is abnormal bleeding, either irregular or excessive.

This bleeding can occur during or between periods, before or after menopause. Uterine polyps are diagnosed by gynecological examination. If the bleeding is very frequent or the polyps are multiple and big, they should be surgically removed by a gynecologist. Hormonal therapy with progesterone analogues is usually short-term.

Uterine cancer and cancer of cervix can also produce bleeding at an unusual time during reproductive period or after menopause.

Infection

Infection of the internal genital organs is a very common cause of abnormal bleeding. Bacterial, parasitic, and fungal infections are the most common and they are usually caused by Chlamydia, Escherichia coli, Candida albicans, and Trichomonas vaginalis. Besides bleeding, infections of genital organs are presented with pelvic pain, bad smell of vaginal discharge, and sometimes with systemic symptoms, such as languor and high temperature.

Always refer to your gynecologist if you notice bleeding between periods or substantial change in frequency of periods, and amount of menstrual bleeding.

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