A comprehensive workup in the Center for Menstrual Disorders, Fibroids and Hysteroscopic Services will shed light on the reason for a woman's bleeding problems. Possible causes include:
- Formed of muscle and tissue from the uterine wall, fibroids are the most common benign tumors in women of childbearing age.
African-American are two to three times more likely to develop fibroids than Caucasian women, and Hispanic women are also at increased risk. Asian women have the lowest risk of fibroids.
- One of the strongest risk factors for fibroids is obesity; extra fat cells produce too much male hormone and store too much female hormone.
- Fibroids only require treatment when they cause problems – such as heavy bleeding, pain, or "pressure symptoms" – constipation or frequent urination. This occurs in about half the cases.
- When vaginal bleeding occurs after menopause, it may be a sign of gynecologic cancer, although younger women can develop these cancers too.
- Ovarian cancer can cause abnormal vaginal bleeding, typically after age 50,
but as early as age 20.
- Endometrial cancer can cause extremely long, heavy or frequent periods after age 40,
with bleeding in between; after menopause, it may cause spotting.
- Cervical Cancer can cause vaginal bleeding after intercourse or between periods, or menstrual flow may be heavier and last longer than usual. This cancer tends to occur
between ages 35 and 55, and can develop after menopause.
- Leukemia, a cancer of the blood cells, can prolong menstrual periods.
Sexually transmitted infections (STIs)
- Gonorrhea and Chlamydia are two sexually transmitted infections that can cause bleeding between periods.
- Chlamydia can also produce painful menstrual periods.
- STIs are normally found in younger women.
Polycystic ovary syndrome (PCOS)
- In PCOS, many cysts (fluid-filled sacs) develop on the ovaries.
- Many women with PCOS are also obese, which increases their estrogen levels.
- PCOS can produce irregular periods and infertility.
Inherited susceptibility to bleeding
A tendency to bleed excessively can be passed down through families via faulty genes. Hemophilia and von Willebrand's disease are two examples; in both cases, women may hemorrhage when they have periods.