Are you having back pain with any of the following?
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
Abnormal vaginal bleeding is common for women of all ages. Bleeding can also come from the uterus and other pelvic organs.
A typical menstrual cycle is between 24 and 35 days long with 4 to 7 days of bleeding. Average blood loss is about 3.5 tablespoons (3 to 4 pads or tampons a day).
You may have light bleeding (spotting) for 1 to 2 days around the middle of your cycle, between periods. Let us know if you:
Treatment depends on the cause of the abnormal bleeding but may include medication, nonsurgical procedures, and surgery.
You may have too heavy or frequent bleeding if:
If you have any of these issues, especially if one continues beyond 2 years from the time you begin menstruating, schedule an appointment.
Call us if you:
Heavy or frequent bleeding has many causes, including the following conditions:
Dysfunctional uterine bleeding (DUB) is irregular bleeding from the uterus. The bleeding can be heavy or light and is usually caused by changes in hormone levels. Sometimes, the ovaries fail to release an egg (anovulation), which may cause unusual bleeding.
We make a diagnosis of DUB after ruling out other causes of the heavy bleeding, such as fibroids, endometriosis, or polyps.
To help us make the correct diagnosis and identify proper treatment, your evaluation may include:
Endometriosis occurs when parts of the lining of the uterus (endometrium) attach to organs outside the uterus in the abdominal area, creating implants. During the menstrual cycle, these implants swell and bleed, which may cause pain and abnormal bleeding.
Treatment for endometriosis usually includes medications and/or surgery to remove the implants.
Adenomyosis occurs when the lining of the uterus grows into the muscle layer of the uterus. It can cause:
Most women do not need treatment for adenomyosis unless it is causing a lot of pain or bleeding. Treatments may include medications and surgery.
Bleeding disorders may cause heavy periods, starting with your first periods in adolescence. Bleeding disorders may reflect certain hereditary conditions:
If we suspect these conditions, we may order blood tests. Treatment depends on diagnosis and the severity of your symptoms.
Light or infrequent bleeding may be caused by one of the following conditions:
These are the most common cause of irregular and infrequent periods. Ovulation occurs when your ovary releases an egg.
Polycystic ovary syndrome (PCOS) is the most common ovulation disorder. When your hormones (estrogen and progesterone) are out of balance, you can develop small cysts in your ovaries and have irregular periods. Treatment focuses on balancing hormone levels. For more information, see PCOS.
Dysfunctional uterine bleeding (DUB) is due to hormone irregularities that affect ovulation and cause irregular bleeding.
We diagnose DUB after ruling out other causes of irregular bleeding, such as PCOS, fibroids, or polyps.
Stress can cause irregular bleeding or missed periods. Travel, relationships, family problems, and work issues can all cause stress.
Too little body fat may prevent your ovary from releasing an egg. If you do not ovulate, you may not have a period. This happens more often in women who are intense athletes, gymnasts, or ballet dancers.
Eating disorders (anorexia and bulimia) and malabsortion disorders like celiac sprue, Crohn’s disease, or ulcerative colitis can interfere with ovulation and stop menstrual cycles.
Too much body fat may also cause irregular bleeding. Sudden weight gain or weight loss may also affect normal menstrual cycle bleeding.
In some cases, unusual bleeding is caused by a growth on or near the uterus or cervix.
Uterine fibroids are noncancerous growths in the wall of the uterus. Fibroids:
You may not have any symptoms with fibroids. However, they can cause:
When you do not have associated pain, the only sign of fibroids may be abnormal bleeding.
If your symptoms are severe, treatments could include medication, nonsurgical procedures, or surgery.
A cervical polyp is a small fingerlike growth on the cervix. Polyps also develop in the uterus. They are typically noncancerous (benign) and can cause heavy or irregular bleeding.
Polyps can cause heavy or irregular bleeding. We can identify cervical polyps during a pelvic exam and usually remove them with a minor procedure.
Hormone-producing tumors are rare growths that can stop menstrual cycles. We diagnose these tumors with a physical exam, blood tests, and sometimes ultrasound.
Cancers of the uterus, cervix, or vagina can also cause vaginal bleeding. We screen for these serious diseases with regular pelvic exams and Pap tests.
The following medical conditions may cause abnormal bleeding.
Infections of the vagina, cervix, uterus, fallopian tubes, or ovaries, such as:
Urinary tract infection (UTI) may cause bleeding from the bladder. Signs of a UTI or bladder infection include:
Thyroid problems may cause abnormal bleeding, especially in women over 40.
A noncancerous growth in the pituitary gland may also be known as prolactinoma. The pituitary gland located at the base of your brain produces hormones, including prolactin. Too much prolactin in the blood may cause unusual vaginal bleeding.
Cushing’s syndrome can trigger irregular bleeding that is often light or infrequent. Cushing’s syndrome is caused by a growth in the pituitary gland that leads to too much cortisol in the blood. Cortisol is a hormone that helps your body respond to stress.
Pregnancy is the most common reason for missed periods. If you have skipped your period after having had sex, take a pregnancy test. Home pregnancy tests are accurate.
You can also stop by our clinic lab. You do not need to make an appointment or bring any paperwork.
Spotting is common during the first trimester. It can happen after an internal exam in the office or after having sex. It happens because the cervix is sensitive to touch during pregnancy.
Miscarriage or tubal pregnancy
Spotting can also be a sign of a miscarriage or tubal pregnancy. A tubal pregnancy occurs when the fertilized egg implants outside the uterus, most commonly in the fallopian tube.
If you are pregnant and experience bleeding or spotting, we may perform an ultrasound and order blood work to determine if the pregnancy is progressing normally.
The female reproductive organs include the ovaries and fallopian tubes, the uterus, the cervix, and the vagina.
Many medications may cause unusual vaginal bleeding.
Birth control methods that contain hormones may cause changes to your menstrual patterns. Examples include:
If you are using your contraceptive method exactly as prescribed, irregular bleeding or lack of bleeding is probably not a cause for concern.
However, if you have any symptoms of pregnancy (nausea, fatigue, or tender breasts), or if you have not used the method exactly as prescribed, take a pregnancy test.
Many other medications can cause changes to regular menstrual bleeding patterns, including:
In addition, medications or procedures used to treat other conditions can also cause irregular bleeding, including:
If you have changes in menstrual bleeding that may be related to prescribed medications, let us know. If you take a medication not prescribed by a doctor, stop taking it and call us.
Together, we can determine the cause of your abnormal bleeding and identify the right treatment for you. During your appointment, we can talk about:
We may prescribe hormones (pills or injection) to help with irregular bleeding.
In addition, nonsteroidal anti-inflammatory drugs (ibuprofen or naproxen) can reduce heavy menstrual flow for some women.
An intrauterine device (IUD) is a small plastic or copper device shaped like a T that is placed into the uterus to prevent pregnancy. It can also be used to treat abnormal vaginal bleeding.
Uterine artery embolization (UAE) is used to treat uterine fibroids. With a UAE, a tiny tube is inserted into an artery in the upper thigh. Then, small particles are inserted into the tube to block blood flow to the fibroids. The fibroids shrink and become inactive.
In some cases, we may recommend treating your abnormal bleeding with nonsurgical methods.
A Mirena intrauterine device (IUD) may help control irregular vaginal bleeding. This plastic T-shaped device is placed inside the uterus during an office visit. It releases hormones that thin the uterine lining.
Common side effects are:
The Mirena also prevents pregnancy and lasts for 5 years. If you decide to get pregnant, it can be removed. If the Mirena slips out, we can insert a new one.
Endometrial (uterine) ablation controls abnormal bleeding by destroying the lining of the uterus with heat or another type of energy.
Scar tissue develops and decreases the amount of bleeding during your period. Your period may stop altogether.
We can perform this procedure in our office. We do not recommend this procedure if you think you might want to become pregnant in the future.
Uterine artery embolization (UAE) is used to treat uterine fibroids. With a UAE, a tiny tube is inserted into an artery in your upper thigh.
We then insert small particles into the tube to block blood flow to the fibroids. The fibroids shrink and become inactive.
As a result, your periods usually become lighter and pain may decrease. We do not recommend that you have a UAE if you are thinking about getting pregnant in the future.
Hysteroscopy is a procedure that we perform in the clinic to remove polyps or fibroids that cause symptoms.
We use a small camera (hysteroscope) to look inside your uterus through the cervix. We then remove the polyps or fibroids through the cervix.
When other treatments are not effective, we may recommend surgery. Together we can talk about the benefits and risks. The following are common types of surgery used to treat abnormal vaginal bleeding.
Myomectomy removes fibroids. We make several small cuts or one large cut in the belly to remove the fibroids.
We might remove the fibroids through the cervix and vagina instead. The uterus is left in place.
The size and location of your fibroids help determine the best method to use. Once the fibroids are removed, your:
Hysterectomy removes the uterus and may be used when you have:
The fallopian tubes, cervix, and ovaries may also be removed along with the uterus. After hysterectomy:
Bleeding in the genital area may also be caused by hemorrhoids or an injury.
Hemorrhoids occur when the veins around your bottom (rectum and anus) swell and bleed. They cause itching, pain, and a hard lump around the anus. Treatment typically includes nonprescription corticosteroid creams or hemorrhoid creams that contain lidocaine to reduce pain and swelling.
Hemorrhoids usually go away within a few days. Let us know if you have a hemorrhoid that does not heal. For more information about treatment, see Hemorrhoids.
Injury or trauma
Bleeding may occur around the rectum or vagina due to trauma to your genital area during:
If you forget to remove a tampon or have a foreign body in the vagina, you may develop irregular bleeding. We can check for these issues with a pelvic exam.
Unfortunately, abusive relationships are common. Abuse can be physical, sexual, or psychological harm. It may include pressuring or forcing you to have sex or do things you are not comfortable with, or refusing to use a condom to protect against pregnancy or sexually transmitted diseases (STDs).
If this is happening to you, you can get help by talking to us, or you may:
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.