abnormal menstrual bleeding

Last reviewed 01/2018

Abnormal menstrual bleeding may classified as:

• excessive:
• with a normal cycle i.e. menorrhagia
• with a short cycle i.e. epimenorrhagia; anovular cycles
• due to disorder of the ovarian endocrine axis
• with a long cycle - usually from dysfunctional uterine bleeding resulting in the condition known as cystic hyperplasia of the endometrium
• reduced:
• infrequent - oligomenorrhoea
• absent - amenorrhoea
• inappropriate:
• precocious - before 10 years of age
• delayed - after 60 years

Notes:

• the management of excessive menstrual bleeding is described in the section on menorrhagia

• anovular bleeding may be regular and cyclical so that to all outward appearances, it is normal menstruation. Anovular cycles are most common at the extremes of reproductive life. Induction of ovulation may be required if infertility is a problem. The management of heavy or irregular bleeding is discussed in the section on menorrhagia.

• short menstrual cycles may occur with normal menses - epimenorrhoea. The cycles are always anovular. This may be the "norm" for the patient in which case, treatment is required only if infertility is a problem - requiring induction of ovulation - or the frequency of the bleeding is an inconvenience - control of the cycle may then be achieved using the combined oral contraceptive pill. In other cases, the phenomenon may be temporary, following recent marriage, abortion or the establishment of menstruation after pregnancy.