Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
When bleeding is not caused by your menstrual cycle, it is called abnormal
or dysfunctional uterine bleeding. This is the most common cause of abnormal
vaginal bleeding during a woman's childbearing years. Up to 10% of women may
experience excessive bleeding at one time or another. African American women
tend to have more episodes.
When the complex hormonal processes of the menstrual cycle are interrupted,
resulting in estrogen and progesterone levels that are out of balance, excessive
vaginal bleeding may occur. This bleeding is related to irregularities of your
menstrual cycle without any disease.
The diagnosis of dysfunctional uterine bleeding is a diagnosis of
exclusion, which means that all other causes for the bleeding (including trauma,
tumors, or diseases) have been looked for and determined not to be the cause of
Depending on the female adolescent or woman's age, there are different reasons for
the person to have
dysfunctional uterine bleeding.
Dysfunctional uterine bleeding is usually associated with an anovulatory
cycle. Anovulation occurs when a menstrual cycle occurs that does not result in
the release of an egg from one of the ovaries.
In some cases, dysfunctional uterine bleeding can occur with ovulation or
the release of an egg from an ovary.
When a woman does not produce an egg, there is still stimulation of the uterus
from the hormone estrogen. Progesterone, a very important hormone produced by a
growing egg, is absent. Therefore, the lining of the uterus becomes unusually
thick and enlarged.
Irregular shedding of the uterine lining and heavy bleeding occurs. The
then experiences heavy, irregular vaginal bleeding (usually painless).
The most common cause of dysfunctional uterine bleeding in a female
adolescent is anovulation.
In the first two years of a female adolescent having a menstrual cycle, 85% of
cycles can occur without the release of an egg.
As the female adolescent gets older, the percentage of cycles that are anovulatory decreases,
and she is more likely to experience normal periods.
By the time the the female adolescent has had a menstrual cycle for six years, fewer than 20%
of cycles will occur without an egg being released from one of the ovaries.
In women of childbearing age (around18-40 years), the most common cause of
abnormal uterine bleeding is pregnancy and its complications such as
pregnancies or miscarriages. Anovulation can be a cause of bleeding in women of
childbearing age. However, anovulation occurs in fewer than 20% of women in this
category, so all other causes, including pelvic inflammatory disease and
uterine fibroids, must be ruled out.
Older women who are approaching
menopause may also experience dysfunctional
bleeding due to the hormonal changes that accompany the menopausal transition.
Diseases of the female reproductive organs may cause bleeding.
A woman may have a harmless (not cancerous) sore (polyp or lesion) on
genitals that can cause bleeding.
Vaginal bleeding is a particular concern in women older than age 50 years
(or after menopause). The risk of cancer increases with age. Also, your vaginal
walls may be dry from lack of estrogen, which may cause bleeding during or after
Certain drugs may cause bleeding, especially if a woman takes
anticoagulant drugs (drugs that prevent the blood from clotting).
Trauma is also a cause of bleeding. An
IUD may cause bleeding (slight
bleeding is usually normal; pay attention to heavier bleeding). Injury (trauma
to the vaginal wall) from sexual intercourse may happen.