Abnormal vaginal bleeding — whether flooding periods, bleeding between periods, or post-menopausal bleeding — always needs investigation. This page covers the causes, the urgent signs, and what tests and scan you need.
The cause of abnormal bleeding depends partly on the age of the patient and the pattern — flooding periods, intermenstrual bleeding, or post-menopausal bleeding all have different differentials.
The most common cause of heavy periods in women 30–50 — fibroids (benign uterine tumours) cause flooding, clots, and sometimes pelvic pressure. Pelvic scan confirms.
Endometrial tissue within the uterine muscle — heavy, very painful periods, enlarged tender uterus. Often missed on standard pelvic scan; requires specialist assessment.
Irregular periods without ovulation — PCOS or perimenopause causing irregular, sometimes heavy bleeding. Hormonal profile and pelvic scan assess.
Intermenstrual bleeding or post-coital bleeding — a small polyp inside the cervix or uterus. Diagnosed by speculum examination and pelvic scan.
Heavy bleeding in a woman of reproductive age who may be pregnant — positive pregnancy test with bleeding always needs urgent assessment.
Post-menopausal bleeding (any bleeding after menopause has been established for 12 months) — requires urgent referral. Endometrial cancer is the most important diagnosis to exclude.
Full Blood Count (FBC) — Measures haemoglobin — quantifies blood loss and identifies anaemia requiring treatment.
Pelvic Ultrasound — Identifies fibroids, adenomyosis, endometrial thickness, and polyps — the primary imaging investigation.
Pregnancy Test — Mandatory for any woman of reproductive age with abnormal bleeding.
Pap Smear + Cervical Examination — For post-coital or intermenstrual bleeding — excludes cervical polyp or carcinoma.
Hormonal Profile (FSH, LH, Oestrogen) — For irregular bleeding — assesses PCOS, perimenopause, or ovulatory dysfunction.
Heavy bleeding that is soaking thick pads within the hour, or is associated with dizziness, needs same-day assessment.
Any woman of reproductive age with abnormal bleeding must take a pregnancy test — even if she is not trying to conceive.
Note when in the cycle the bleeding occurs, how heavy, how many pads/day, any clots, any associated pain — this significantly helps the clinical assessment.
Any bleeding more than 12 months after the last period should be assessed urgently — same week at the latest.
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