In our last blog we covered two possible causes of intermenstrual bleeding and heavy periods. This can be worrying situation for a woman and and can have a big effect on everyday life.
There is not always an underlying cause, but it can be a result of many different types of problems. This is why it is so important to speak to your GP about your symptoms. Your GP may examine you, take some blood and urine samples, or arrange a smear test or an ultrasound scan.
Literature states that transvaginal ultrasound is the primary test in the detection and evaluation of gynaecological pathologies. As a considerably simple and non-invasive method, it has a good accuracy rate in diagnosing uterine or ovarian abnormalities. Transvaginal scan is preferred over the transabdominal method as it enables better visualisation of the ovaries and endometrium.
One of other causes can be pelvic inflammatory disease (PID). PID is an infection of the female upper genital tract, including the uterus, fallopian tubes and ovaries. Most cases are caused by a bacterial infection that’s spread from the vagina or the cervix to the reproductive organs higher up. If diagnosed at an early stage, PID can be treated with a course of antibiotics, which usually lasts for 14 days. You might be given a mixture of antibiotics to cover the most likely infections, and often an injection as well as tablets.
The early stages of an infection bring accumulation of simple fluid in the endometrial canal, fallopian tubes and pelvis, which are visible on ultrasound. As the disease progresses, the fallopian tubes become thicker and fill with complex fluid. Later, tubal-ovarian and pelvic abscesses form thick-walled, complex fluid collections.
Also, Polycystic Ovary Syndrome can cause irregular bleeding (PCOS). The exact cause of PCOS is unknown, but it often runs in families. It’s related to abnormal hormone levels in the body, including high levels of insulin. Insulin is a hormone that controls sugar levels in the body. This contributes to the increased production and activity of hormones like testosterone. Polycystic ovaries contain a large number of harmless follicles that are up to 8mm (approximately 0.3 inch) in size. The follicles are underdeveloped sacs in which eggs develop. In PCOS, these sacs are often unable to release an egg, which means ovulation does not take place. The images found on the ultrasound, in conjunction with the results of blood tests and a thorough examination of both you and your medical history, are used to diagnose this syndrome.
In the past lots of women were diagnosed with PCOS and they have changed the diagnostic criteria for the following. The Rotterdam Criteria, the current diagnostic criteria for women with PCOS, state that a woman has PCOS if she has following three criteria:
- Absent or irregular menstrual cycles (eight or fewer periods in one year). Since only two of these three criteria need to be met, there are some women who will meet the criteria for a diagnosis of PCOS despite having regular monthly menstrual cycles.
- High androgens on blood work or signs of high androgens in the body such as acne, excessive hair growth, or male pattern hair loss. Blood tests often reveal elevated testosterone and free testosterone levels.
- The presence of follicles-commonly referred to as cysts erroneously—on an ultrasound. Some criteria define PCOS as having 12 or more small follicles in both ovaries. However, doctors do not typically rely solely on that definition in order to make a diagnosis.