Patterns of Bleeding

Introduction
Terminology
Patterns of Bleeding
Causes of Menstrual Abnormailities
Diagnosis
Treatment
Myths
Summary

As you can now appreciate, when a woman is ovulating normally, she has normal regular menstrual cycles. When a woman does not ovulate normally or does not ovulate at all, her menstrual cycles become irregular. When a woman has any abnormality of ovulation, the irregular menstrual cycles can take any pattern they wish.

While the actual pattern of the irregular bleeding may or may not be all that helpful in determining the cause, I do not wish to create the impression that it is totally unimportant. For instance, when a woman has a totally erratic bleeding pattern without any predictable flow, that woman has almost certainly stopped ovulating. On the other hand, if a woman has regular periods but the flow has become exceedingly heavy, some organic problem such as a fibroid tumor in the uterus becomes a more likely cause.

The age of the woman is also a major clue as to what may or may not be the cause of her irregular bleeding pattern. A teenage girl whose endocrine system has not yet fully matured will have totally irregular bleeding with either very infrequent periods or very heavy irregular periods, simply because she has not yet established a normal ovulatory menstrual cycle.

As a general rule of thumb, teenage girls can have irregular periods for up to two years after menarche (the age at which they have their first period) because they have not yet developed a regular ovulatory cycle.

If a teenage girl continues to have significantly irregular periods more than two years after menarche, the likelihood is that she will maintain that irregular bleeding pattern and the cause for that should be looked for.

For women in their twenties and thirties, organic causes of the irregular bleeding are the more likely source of the problem. Complications related to a pregnancy are very common. Many women conceive and do not realize that they have become pregnant. When they have irregular bleeding that might signal an impending miscarriage, this must be considered. Fibroid tumors in the uterus are not rare in women at this time of their life. Other organic problems that can cause irregular bleeding include endometriosis and ovarian cysts.

For a woman in her late thirties and forties, organic disease of the uterus, most commonly either fibroid tumors or adenomyosis, are major causes of abnormal bleeding. Furthermore, as a woman ages, the ovulatory process begins to breakdown and failure to ovulate normally, or failure to ovulate at all, again becomes a common reason for irregular bleeding, just as it was in the teenage girl.

This is not to say that any of these problems cannot occur at any age. However, the age of the woman does give a major clue as to where the more likely causes will be found.

The only other time the pattern itself becomes of major importance is when the woman is completely amenorrheic since the diagnostic approach has to be modified.