"Look Inside" Dr. Winnifred Cutler's essential book; an excerpt from Chapter 5 for readers.
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Copyright © 2009 John Wiley & Sons, Inc.
Hormones and Your Health: The Smart Woman's Guide to Hormonal and Alternative Therapies for Menopause
Excerpt pp 77-80
What does it mean when your uterus or pelvic organs send out distress signals, such as unexpected bleeding or pain with intercourse? It means you must take action to find the cause.
Unexpected Vaginal Bleeding
For every menstruating woman, bleeding is a fact of life; it’s healthy, functional bleeding—it has a purpose. Bleeding that is not expected is labeled dysfunctional. Dysfunctional uterine bleeding (DUB) is also called abnormal uterine bleeding, excessive menstrual bleeding, or menorrhagia (heavy menstrual bleeding). The good news is that abrupt changes in the length of the monthly cycle are often normal. Sudden changes in your sex life (ending a relationship or starting one after a time of celibacy) can cause hormonal and bleeding changes, but that has to do with the rhythm of your sex life, not with an underlying pathology.169
Aging can also bring changes: Hormonal secretion from your ovaries triggers a variety of normal changes in blood flow, timing, duration, and character, beginning around age 43 until menopause. All are part of the expected pattern of the change of life. And hormonal therapy regimens themselves generate their own patterns of “normal withdrawal bleeding.” But unexpected bleeding can also be a signal of disease and/or endocrine dysfunction. When you don’t know why you’re experiencing the bleeding, you need to consult your doctor.
As women approach menopause, their last 60 menstrual cycles normally contain a wide variety of cycle lengths.104 It is not unusual for the last cycles to range from 10 days to 20, 30, or even 60 days from the onset of one bleeding sequence to the onset of the next. Again, most unexpected bleeding is not caused by any pathology. A prescription for sequential HRT can often regularize this pattern.
How much blood loss is abnormal? You would have to lose at least 80 millileters (5.3 tablespoons) per cycle. Frankly, you won’t be measuring your flow, but you’ll know that it’s too much or too heavy if you have accidents in public, can’t leave the house, or otherwise lose control of your personal hygiene.657 Schedule a thorough medical evaluation and screening to rule out four potential causes. All of them need to be checked because more than one cause can coexist.
Fibroids occur in 80 percent of women and are a common cause of bleeding. They are discussed in Chapter 7.
Blood disorders can cause abnormal bleeding The most common is Von Willenbrand’s disease, which is found in 13 percent of women who experience heavy uterine bleeding.544 Symptoms that suggest this disease include easy bruising, frequent gum bleeds when flossing, one or two nose bleeds per month, and intervention-related bleeding at childbirth, tooth extraction, and/or surgery.416
If you have any of these symptoms along with abnormal vaginal bleeding, you need to locate a specialized center that has expert knowledge of blood disorders. It has been well documented that many analytical errors have been made by medical offices that do not specialize in blood disorders, so you will want to avoid the possibility of a misdiagnosis.have383, 416 Your gynecologist should be able to recommend a specialized center.
Insist on a thorough screening for any blood disorders. Recent evidence indicates that 10 to 15 percent of women who would have previously been misdiagnosed as having “ovulatory dysfunctional uterine bleeding” will actually reveal a systemic blood disorder if appropriate detailed testing is carried out.248 Other rarer blood abnormalities include:
Other systemic problems that are associated with heavy bleeding include:
**This Chapter is complex and very important. These topics are also covered in this chapter:
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