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Written by: Kathryn Danzey

What are common causes?

1. Hormone imbalances – this is by far the commonest cause.

2. Fibroids or polyps involving the cavity of the womb (uterus)

3. Abnormal cells developing in the lining of the womb. Abnormal cells do not always infer cancer, they may be overactive cells.

4. Occasionally, the bleed may come from the cervix e.g. polyp

How do I know what is the cause in my case?

In addition to an internal examination which provides essential information, the following investigations are often advised:

1. Ultrasound scan – this will establish if there is any fibroid or polyp. There are two types of ultrasound scan:

External, when the ultrasound probe is placed over your tummy during the examination.

Internal, when the ultrasound probe is placed into the vagina during the examination. This is often preferred because it produces a clearer picture of the uterus and can pick up small polyps or fibroids when external scan can’t.

2. Biopsy – this may establish if the cells in the lining are normal or not. It may be carried out as an outpatient procedure by the use of a fine instrument called Pipelle. It is often performed without an anaesthetic, although it may be uncomfortable/painful. However, the procedure often lasts for only a few seconds. The biopsy procedure has largely replaced the old fashioned “D & C” (scrape of the lining of the womb). However, a “D & C” may be needed if it is not possible to obtain a biopsy.

If the above two tests are both normal, by way of exclusion, the most likely explanation of your abnormal bleeding is hormonal imbalance.

What will happen after the biopsy?

1. You may have some crampy lower tummy pain for a few hours, and spotting/light vaginal bleeding for a day or two.

2. Mr Li will contact your in about a week’s time to let you know the result of the biopsy. If you have not heard from him 14 days after the biopsy, please contact him or his secretary on 0114 2550365.


The treatment of course depends on the underlying cause.

1. Hormone imbalance – if the abnormal bleeding is not too troublesome, you may feel no treatment is needed. If the abnormal bleeding is causing problems, hormone treatment may be considered. The hormone used is often a progestogen. Alternatively, there are also non-hormonal medications which reduce the amount of menstrual flow (e.g. tranexamic acid).

2. Fibroids/polyps – further assessment by hysteroscopy may be advised. Hysteroscopy refers to the examination of the inside of the womb with a lighted telescope and is performed either as an outpatient procedure, or as a day case in hospital (under general anaesthetic). The latter option has the advantage that the fibroid or polyp may be removed at the same time.

3. Abnormal cells – depending on the degree of abnormality, you may be advised to have hormone treatment, further investigation e.g. hysteroscopy, or hysterectomy.

What if tablet treatment doesn’t work?

The possible options of treatment then include:

1. Hormone coil: the Mirena coil releases a small amount of progestogen hormone every day into the cavity of the womb. It also provides effective contraception and the beneficial effects last three years.

2. Endometrial resection/ablation: this method refers to the destruction of the lining of the womb by electrical or thermal means. It is performed via a hysteroscope, often as a day case, under anaesthetic. However, it is effective in only 70-80% of cases. There is no scar involved and you may be able to return to work within one week of the operation. This method is more suitable for women within a few years of the menopause.

3. Myomectomy – this refers to the removal of the fibroid followed by reconstruction of the uterus.

4. Hysterectomy – this is considered as the last resort when everything else have failed to control the period problem.

Prof T C Li

Consultant Gynaecologist
7 Williamson Road
Sheffield S119AR
Tel: 0114 2550365

About the Author

Kathryn Danzey
I have a passion to bring to you what really works in the beauty industry, from a moisturiser to the latest advanced treatment for anti ageing. After almost 4 decades in the industry I'm packed with info to share but never tire of looking for new things and would love you to share your experiences with us too. We're here to help you find that treatment or product that will make a change for you. Can't do without My Collagen Shots and H3O Night Repair. Love a great serum and UV protection

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