This past week marked the International Women’s Day (or IWD for short). IWD was started almost 100 years ago mainly to raise a voice against discrimination and bias towards women.
As I primarily deal with women’s health matters, it is only befitting that this week’s article addresses one of the primary reasons why women seek gynaecological consults.
Abnormal bleeding rates as the most common reason why women end up in gynaecology clinics. The definition of abnormal bleeding is somewhat vague. But any bleeding that deviates from a regular and predictable menstrual bleeding pattern can be described as abnormal.
Every woman has their own unique monthly bleeding pattern in terms of quantity, duration and predictability. If you deviate from what appears normal to you, you could interpret that as abnormal.
It goes without saying that bleeding too much (or too little), too frequently (or infrequently), or too unpredictably can all be taken as abnormal. So too is severe pain with bleeding. Once you realise that you have an abnormal bleeding pattern that bothers you, the next thing is to get it addressed.
The choice of who to see usually swings between a family physician and a gynaecologist. Seeing a gynaecologist from the outset may be more preferable. The diagnostic pathway for abnormal bleeding is usually focused on identifying the cause, and recommending an appropriate remedy.
Your doctor will initially review your bleeding pattern, and work out how it deviates from the norm. A gynaecological exam may be necessary so as to exclude obvious causes.
But more often than not, additional tests are required. Such tests may include gynaecological imaging, blood tests, and screening tests for gynaecological cancers for older folk.
Most women with abnormal bleeding will not be found to have any serious disease conditions. Some will not even require any specific treatments, and their abnormal bleeding may spontaneously resolve. Others will benefit from hormonal or even non-hormonal control of the bleeding. Certain diagnoses may require specific treatments that may include surgery or combinations of treatment approaches.
There must always be a cautious approach in the extremes of age. This includes young girls, and older women in the fourth decade and beyond. Bleeding patterns during puberty and adolescence can be so variable that a more conservative approach should be the norm.
Most young girls will often settle down to a more predictable bleeding pattern in the course of time. Subjecting them to extensive medical exams and tests is usually not necessary.
Older women with abnormal bleeding patterns have a higher risk of having a more serious gynaecological disease. Their evaluation should always be well structured and thorough.
Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist.
amurage@mygyno.co.ke
