Vaginal bleeding - when it is abnormal

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The "normal" state of affairs for Western women, between the menarche (start of periods) and menopause (end of periods) is for a loss of blood from the vagina every 28 days (range 26-30) which tends to be heavier on the first day or two, then becomes progressively lighter and dries up after 3-7 days. Individual women get a regular pattern or "shape" to their period which is recognisable. Anything different from this normal "shape" should be investigated.

Bleeding from the vagina occurs for two possible reasons. Either there is hormone malfunction or there is something going wrong in the tubes, womb, cervix, vagina or vulva. This is a very important distinction - only too often I see women being put on hormones (such as the Pill or HRT) to control bleeding when a proper diagnosis has not been made.

Progesterone has now been classified as a Class 1 carcinogen by the World Health Organisation and so should not be given without very good reason. Oestrogen is also a growth promoter and the same applies.

It is not unusual to get "wobbles" at the menarche or menopause. These occur when the pituitary and ovaries are either getting going or running down. There may be other wobbles with other major hormone disturbances such as after delivery of a baby, breast feeding (when with a constant level of progesterone, the periods usually stop), stopping the Pill or major stressful events.

Causes of abnormal vaginal bleeding

Local causes of bleeding should always be investigated first by a doctor. This is because serious pathology always needs excluding as a matter of urgency. Cancer of the womb, cervix, vagina and vulva may present with abnormal vaginal bleeding.

Other causes include:

  • Forgotten tampon (can cause septicaemic shock - "toxic shock syndrome").
  • Miscarriage.
  • Ectopic pregnancy - always consider it if there is a late period, and/or pain, especially shoulder pain. Also see The acute abdomen - a surgical emergency
  • Infection - see Pelvic Inflammatory Disease
  • Cervical polyp - can be seen at an examination for cervical smear.
  • Cervical erosion - can be seen at an examination for cervical smear.
  • Thinning of the vagina (can be a problem of the menopause).
  • Thinning of the vulva (can be a problem of the menopause).

Cervical polyp

This can be easily twisted off by the gynaecologist. It is usually done in hospitals just in case the stump bleeds and surgery is necessary.

Cervical erosion

An erosion is really a misnomer. It occurs where the lining of the womb becomes visible at the cervix. It is only a problem if it causes bleeding because this bleeding needs to be distinguished from other causes of bleeding.

Cervical inflammation

This is often reported at a cervical smear and needs further investigation for infection.

If local causes of bleeding have been excluded

A regular menstrual cycle is a very good indication of good health. This was highlighted in a paper by Margaret and Arthur Wynne who demonstrated that hormonal wobbles resulting in irregular, heavy or painful periods are often caused by poor nutritional status. An extreme example of this would be the anorexic woman whose periods will completely stop. This is Nature's way of saying you are not well enough to have a baby!

Lesser degrees of good health will result in menstrual irregularities.

The standard medical treatment for menstrual irregularities is to prescribe hormones. This is nutritionally disastrous partly because the hormones will induce further deficiencies in their own right and partly because giving hormones substantially increases one's risk of heart disease, cancer, infections, mood changes and so on.

So an irregular cycle is indicative of poor health which needs tackling through the general approach to treating disease, i.e.

Because we live in an increasingly polluted world I am coming to the view that we should all be doing detox regimes - see Detoxification - an overview.

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