Abnormal Bleeding / Menstruation

Understanding the Menstrual Cycle

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Women of reproductive age develop a thickened endometrial lining each month in preparation for pregnancy. If fertilization does not occur, the endometrium sheds and exits through the vagina as menstrual blood, which may appear dark red or brown.

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Before menstruation, various symptoms may occur, including headache, bloating, irritability, muscle and joint pain, breast tenderness or enlargement, increased appetite, and menstrual cramps. Some symptoms are related to hormonal fluctuations during ovulation, while others may be warning signs of underlying conditions such as uterine or ovarian polyps and tumors.

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Characteristics of a Normal Menstrual Cycle

• Cycle length ranges 24–38 days, with a variation of no more than 7 days.

• Bleeding lasts 3–8 days per cycle.

• Total menstrual blood volume is approximately 30–80 mL.

• No blood clots should be present.

 

Characteristics of Abnormal Menstruation

• Cycles that are too frequent or too infrequent

• Spotting or irregular bleeding

• Excessive menstrual flow or the presence of blood clots

• Bleeding between menstrual periods

 

Possible Causes of Abnormal Menstruation

Causes vary depending on age:

• Adolescents: Chronic anovulation or hormonal imbalance

• Reproductive age: Uterine polyps, fibroids, or abnormal cervical cells

• Perimenopausal or older women: Possible indicator of malignancy

If abnormalities occur, you should consult a gynecologist for a detailed history, pelvic examination, and pelvic ultrasound to evaluate lesions, uterine size, fibroids, polyps, adhesions, and adnexal structures. Cervical cancer screening should be performed concurrently, as cervical lesions can also cause abnormal bleeding.