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Abnormal menstrual bleeding


Abnormal uterine bleeding occurs when there is excessive bleeding between periods. Polyps, fibroids, endometriosis, infection and forms of contraception are associated causes of abnormal uterine bleeding.

What is abnormal uterine bleeding?

Heavy bleeding between periods can be concerning for most women, but severe blood loss from menorrhagia can disrupt your daily routine, causing blood loss and menstrual cramping. Your menstrual flow is too heavy if your sanitary pad or tampon is soaked within two hours.

Why is abnormal uterine bleeding associated with pelvic pain and infertility?

Apart from unusual excessive menstrual bleeding, you will most likely experience excruciating pelvic pain associated with abnormal uterine bleeding that may require urgent medical attention. Cervical lesions and an infectious endometrial lining can cause endometritis leading to infertility in women. Ectopic or early pregnancies are prematurely failed pregnancies that occur when the fertilised egg lodges in the narrow fallopian tube instead of the uterine lining leading to abnormal uterine bleeding.

What are the related symptoms?

Signs of abnormal uterine bleeding include:

  • Sanitary pad soaking after every hour
  • Bleeding that lasts longer than a week.
  • Passing blood clots more extensive than a coin
  • Anaemia
  • Fatigue
  • Shortness of breath

What causes abnormal uterine bleeding?

Abnormal uterine bleeding may arise from infection from invasive contraceptives. A pelvic disease causes bleeding between periods accompanied by a high fever, painful sexual intercourse as well as foul-smelling vaginal discharge and is usually a sign of abnormal uterine bleeding. The insertion of a foreign body, such as a copper T intrauterine device (IUD) as well as hormonal contraceptives such as rods that are implanted in the arm releasing small amounts of progesterone and injections releasing synthetic progesterone prompts abnormal uterine bleeding.

Structural uterus irregularities arise from polyps, fibroids and adenomyosis. Tiny, corn-like projections known as polyps associated with fibroids grow out from endometrium (uterus lining) resulting in abnormal uterine bleeding. Women who suffer from uterine polyps experience excessive menstrual bleeding and prolonged periods of bleeding from menorrhagia. Polyps usually develop in women in their 40s and 50s and are likely to occur after menopause, rarely affecting women under twenty. A woman going through menopause who refrains from hormone replacement therapy should not experience vaginal bleeding. If this does occur, there may be the presence of abnormal growth in her uterus, and she should seek urgent medical attention.

How is abnormal uterine bleeding diagnosed?

Women over thirty-six years of age who have a family history of cancer and abnormal uterine bleeding may undergo a biopsy of the endometrium. A biopsy involves examining a piece of tissue taken from the endometrium to check for signs of cancer or cell abnormalities to diagnose abnormal uterine bleeding.

Dr Benecke will perform a diagnostic hysteroscopy by inserting a hysteroscope before dilating the cervix. A gas or liquid solution is pumped to expand the uterus to clear mucous and blood. The light emitted from the hysteroscope enables a closer inspection of the opening of the uterine cavity and fallopian tubes to diagnose abnormal uterine bleeding.

Ultrasounds capture images of the vagina, cervix, ovaries, uterus and fallopian tubes to detect ectopic pregnancies, abnormalities in the cervix and placenta determining the cause of excessive bleeding to help diagnose abnormal uterine bleeding. A vaginal ultrasound involves inserting a lubricated, sheath-covered probe into the vagina to examine the cervix, fallopian tubes, ovaries and uterus.

What does treatment for abnormal uterine bleeding involve?

Treatment for abnormal uterine bleeding depends on the severity of the case and may include taking prescription medication such as antibiotics or undergoing hormone replacement therapy. Dilatation and curettage treatment involves dilating and carefully scraping the lining of the uterus and cervix to treat abnormal uterine bleeding. A hysterectomy is a last resort to treat abnormal uterine bleeding and reduce the risk of cancer.

Dr Benecke is committed to diagnosing and finding the best possible treatment measures to minimise the excessive flow of blood during menstruation. The Endometriosis Clinic’s team of mental health professionals and counsellors strive to resolve psychological issues related to chronic pelvic pain and abnormal uterine bleeding.

Specialised Services

While Dr Benecke is a gynaecologist & obstetrician offering the full range of women's health services, his niche lies in the treatment and management of the following gynaecological conditions:


Due to the complexity of the diagnosis, Dr Benecke is meticulous during each consultation and using a multidisciplinary approach he can provide highly specialised treatment and management of this condition as well as the related symptoms such as chronic pelvic pain and the complication of infertility.



Sharing similar symptoms to that of endometriosis, fibroids are growths that develop on the uterus. The size of fibroids can range, growing from the size of a pea to the size of a watermelon, distorting the uterus and causing disabling symptoms.



Polycystic ovary syndrome (PCOS) is a hormonal disorder that disrupts oestrogen production and causes an imbalance of the male hormones, androgens. PCOS causes disruption of the menstrual cycle leading to complications such as severe abnormal uterine bleeding, the development of numerous fluid-filled cysts in the ovaries and infertility.