Intermenstrual bleeding, irregular bleeding and heavy periods can be worrying and they can have a big effect on a woman’s everyday life.

They do not always have an underlying cause, but they can result from many different types of problems, so it’s important to speak to your GP about your symptoms. Your GP may examine you, take some blood and urine samples, 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 is enables better visualisation of the endometrium.

One of the possible causes of intermenstrual bleeding and heavy periods can be endometrial polyps.

Endometrial polyps are overgrowths of stroma and glands that project into the uterine cavity. They may be single or multiple and usually consist of irregularly distributed endometrial glands, stroma, and blood vessels. They are usually asymptomatic and the majority of them are benign, but may cause abnormal uterine bleeding. In women experiencing abnormal bleeding, the prevalence of endometrial polyps ranges from 13 to 50%. Ultrasound appearances of endometrial polyps are of focal endometrial thickening, with cystic appearances of the endometrium with a so called ‘feeding vessels’ can be seen.

Ultrasound scan to examine the lining of the uterus to exclude endometrial polyps are mostly ideal 4 days after your menstrual period started.

The other possible cause of irregular bleeding and heavy periods are fibroids.

Fibroids are non-cancerous growths that develop in or around the uterus.

Fibroids are made up of muscle and fibrous tissue, and vary in size. They’re sometimes known as uterine myomas or leiomyomas. The exact cause of fibroids is unknown, but they have been linked to the hormone oestrogen. Oestrogen is the female reproductive hormone produced by the ovaries. Fibroids usually develop during a woman’s reproductive years (from around the age of 16 to 50) when oestrogen levels are at their highest.

Fibroids can grow anywhere in the uterus and vary in size considerably.

The main types of fibroids are:

  • intramural fibroids – the most common type of fibroid, which develop in the muscle wall of the uterus
  • subserosal fibroids – fibroids that develop outside the wall of the uterus into the pelvis and can become very large
  • submucosal fibroids – fibroids that develop in the muscle layer beneath the uterus’ inner lining and grow into the cavity of the uterus

Fibroids can be detected on transvaginal ultrasound scans and if necessary your GP can opt to refer you to your local Gynaecology team for possible treatment.

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