- Women's Health
Spotting Between Periods:Causes and Treatment Options
Spotting refers to menstrual bleeding that occurs between a woman's regular periods.
COMMON CAUSES OF BLEEDING BETWEEN PERIODS
#1. Dysfunctional uterine bleeding (DUB)
Dysfunctional uterine bleeding is defined as an abnormal uterine bleeding that occurs in the absence of recognizable pelvic disease,general medical disease or pregnancy.It is caused by changes in hormone level.It occurs when body’s hormonal control and feed back mechanism in hypothalamic pituitary unit is disturbed.This is particularly common at the extremes of the reproductive years. When ovulation does not occur, no progesterone is produced to stabilize the endometrium; thus, proliferative endometrium persists .Bleeding is irregular,unpredictable and the woman is unable to ovulate.This disturbance in hormonal level may be persistant,chronic or temporary which lasts just for one cycle.
Medically DUB is treated:
- A synthetic progesterone (for example, Provera or Primolut) is used to try to interrupt the abnormal hormonal pattern and regulate the cycle.
- A progestogen (levonorgestrel)-releasing IUD can also be inserted to reduce bleeding.
Bethroot(Trillium erectum) contains saponins (plant hormone-like substance) which have the ability to regulate both the hormonal balance and blood flow. This herb can regulate both cycle length and menstrual loss within 1–3 cycles and is considered to be ‘specific’ for the treatment of DUB which is caused by failure to ovulate. Bethroot is often prescribed with Vitex agnus-castus.
Another herb that can help is Lady's Mantle(Alchemilla vulgaris).It has anti-hemorrhagic effects and is believed to improve progesterone production,making it an effective remedy to treat DUB. Lady’s mantle is available as tea, liquid extract, and oil.According to webmed’’ Alchemilla is POSSIBLY SAFE for most people when taken by mouth appropriately. Although some German researchers warn about possible liver damage, other experts consider the concern to be exaggerated’’.
How to Make Lady’s Mantle Tea
- Steep(for 10 mins) 1ounce of dried leaves in 1 pint of boiling water to make tea
- take 3 times daily until symptoms disappear.
This tea will boost up your metabolism and also help you lose weight quickly.It has long been used in Arab countries for weight loss.It's high tannin content arrests bleeding both externally and internally.
- Children,pregnant or breast feeding mothers should not take Lady's mantle.
- Women suffering from cancer and heart disease should consult their doctors before using lady’s mantle.
- Blood Thinners,Such as aspirin, warfarin (Coumadin) and clopidogrel (Plavix) should not be combined with Lady’s mantle.
- women taking iron supplements or other medications for treatment of anemia should avoid Lady’s mantle because it interferes with absorption and effectiveness of these drugs.
This is a condition when there is an excess of estrogen but not enough progesterone to counter balance it.The cells may grow in response to estrogen level and the endometrium( mucous membrane that lines the inside of the uterus ) may become very thick.The cells making the lining of uterus may become abnormal.It’s not cancer but it may lead to cancer.Diagnosis of endometrial hyperplasia is done by taking a sample of tissue from endometrium and examining it under the microscope.
Common symptoms of endometrial hyperplasia are:
- erratic bleeding pattern
- spotting or
- heavy flow.
Risk factors associated with endometrial hyperplasia.
- Cigarette smoking
- Family history of uterine cancer
- Never having been pregnant
- Personal history of diabetes or ploycystic ovarian syndrome
The medical approach
The aim of treatment is to remove the abnormal tissue and then establish cyclic shedding of the endometrium—initially with drugs.
- The affected endometrium is removed with a D&C( Dilation and curettage is a procedure to remove tissue from inside of uterus).
- To rectify the abnormal hormonal pattern, synthetic hormones are recommended to simulate a hormonal pattern similar to the normal menstrual cycle. Usually, a progesterone is given by tablet.
- Ovulation often starts spontaneously after a few cycles on progesterone.
The most important herb for treatment of endometrial hyperplasia is Lady’s mantle (Alchemilla vulgaris).Other herbs like Yarrow( Achillea millefolium )and shepherd's-purse (Capsella bursa-pastoris) have also been found to be effective for this condition.Shepherd's purse is rich in antioxidants and thus has cancer preventive action.
A number of studies have demonstrated the protective role of some of the anti-oxidants. Their effects on the endometrium may prevent endometrial hyperplasia turning ito a cancerous condition. Those shown to have a protective effect are the vitamins A, E, K and C, beta-carotene and the mineral selenium.
The tincture of Shepherd's Purse:
To get Shepherd’s purse to work for this is to take it in small and frequent doses, until the bleeding has stopped.Mainly depending on the strength of the tincture 20 drops or 1 ml of Shepherd’s purse each time is usually enough.
You have to spend time with herbs to understand them.They are much more a living medicine than are drugs. The first step is to feel them working, the second step is to get a sense of how often you need to use them and in what dose.
#3.Malnutrition or excessive weight loss
Malnutrition may be caused when the food is unavailable,inadequate or an extreme calorie restricted diet is followed.This leads to nutritional deficiency and interferes with menstrual cycle.Losing a lot of weight in a short period of time also interrupts a regular cycle.periods may cease or infrequent and heavier period occur.
It’s most common in women over 40. symptoms include :
- unusual or irregular vaginal bleeding between periods
- pain with sex
- pelvic pains.
The exact cause of uterine cancer is not known but the incidence increases with :
- women who never had children
- estrogen therapy
- radiation to the pelvis
- family history of uterine cancer
women who are over 40 and experience unusual vaginal bleeding should not ignore or take lightly any vaginal bleeding and have the symptoms investigated promptly.
A polyp is an overgrowth of tissue, which is attached by a stem to the tissue. Gynaecological polyps may form in the cervix or uterus. The cells of the polyp are usually normal, but can bleed easily or cause pain because of their position. Common symptoms of uterine polyps are:
- irregular bleeding
- excessively heavy menstrual periods
- bleeding after menopause
Women over 40 with cervical polyps may also have uterine polyps.
The medical approach
Uterine polyps can resolve spontaneously.
- Polyps associated with bleeding between periods are removed hysteroscopically under a general anesthetic.
The natural therapist’s approach
Treatment seeks to normalize hormonal stimulation of the endometrium with herbs such as Vitex agnus-castus and uses the uterine tonics, anti-haemorrhagics or emmenagogues to transform the endometrium and expel the polyp. postmenopausal women, and those with menorrhagia or spot bleeding, are advised to seek medical advice for surgical removal.
Hormonal contraceptives can be associated with abnormal or unsual bleeding patterns.Examples include;
- The combined (oestrogen and progesterone) Pill
- the sequential Pill (pills containing oestrogen and progesterone which are varied throughout the cycle)
- the Mini Pill (progesterone only)
- Depo-Provera (an injection of slowly absorbed progestogen)
This used to be cervical erosion but now commonly called cervical ectropian or cervical eversion.some women are born with cervical ectropian but in others it may be caused by hormonal changes due to pregnancy or contraceptive pills.cervical ectropian does not cause cervical cancer or any other type of cancer.Common symptom is discharge accompanied by pain or contain brownish blood with offensive odor..
The medical approach:
- Some women may be advised to stop the pill.
- If inflammation or infection are a problem,the area is treated with diathermy or laser treatment.
Local astringent remedies which improve the tone and strength of the mucous membranes, treat secondary infection and stop bleeding are used for cervical eversion. Cervical eversion is considered to be associated with Heat and Moistness, and the remedies chosen are Cooling and Drying.
- Goldenseal (Hydrastis Canadensis) is the preferred herb for cervical eversion, either in the form of a cream or wash. Treatment should be continued until all inflammation has been removed.
- Agents like tea tree Oil may be too harsh for this and should not be used in concentrations higher than 5 %.A cream containing 5% tea-tree oil in an aqueous or vitamin E may be effective for treatment of cervical eversion.
- Women who are taking the Pill, and who would like to continue to do so, may find that their symptoms are helped with folic acid and B complex vitamins.
Cervicitis is an infection or inflammation of the cervix.It is usually caused by bacteria. Often the woman is in poor health or her vaginal environment is altered sufficiently for opportunistic infections to develop. Symptoms involve:
- Grayish or pale yellow vaginal discharge
- Bleeding between periods
- Bleeding after sex
- pain on moving the cervix during sex
- Pain when the cervix is examined
The diagnosis is usually on the basis of an offensive or blood-stained vaginal discharge and pain on moving the cervix, either during sex or when the cervix is examined.
The medical approach:
- Cervicitis is often treated with antibiotic creams, and in some cases, oral antibiotics as well.
- Creams and pessaries are inserted at night to keep the medication near the cervix.
Astringent and antiseptic creams are used for cervicitis. Creams which are applied at night are favored because they stay in contact with the cervix for longer. The herbs Hydrastis canadensis, Calendula officinalis and tea-tree oil are effective in the treatment of cervicitis.
Ovarian cysts are fluid filled sacs that form in ovaries.They are usually common during childbearing years.Ovarian cysts may be benign or malignant.some cysts are associated with unusual bleeding.
Some women experience spotting with or without pain during normal ovulation.This bleeding is thought to be caused by changed in estrogen level at mid cycle.The symptoms however,should be investigated.
#11.Pregnancy and bleeding
i) Placental malfunction
Bleeding can occur as a result of placental malfunction, and is of three main types.
• Bleeding associated with abnormal development of the placenta and often the fetus.
• Bleeding associated with a normally developing placenta, which is situated in the wrong place. This is referred to as a ‘placenta praevia’.
• Bleeding associated with a normal placenta which dislodges from the uterine wall prematurely. This is called an ‘accidental hemorrhage’ and is accompanied with considerable pain.
A molar pregnancy also known as hydatidiform mole, is a benign tumor that develops in the uterus. A molar pregnancy occurs when a fertilized egg does not lead to normal pregnancy but an abnormal mass of tissue that secretes a large amount of human chorionic gonadotrophin (HCG) hormone .This causes severe morning sickness.The bleeding may start about 10–12 weeks into the pregnancy,and continue until all the hydatidiform mole is expelled.
As this tissue can become cancerous, so it’s necessary to have a D&C to ensure that all the tissue is removed, and have hormonal (HCG) monitoring for another year.
iii) Ectopic pregnancy
In normal pregnancy the ovary releases an egg into fallopian tubes.If the egg meets a sperm,it moves to uterus attaches to uterine lining and stays there for nine months.But in ectopic pregnancy the fertilized egg may stay in fallopian tube,which might result in tubular rupture.this condition is very serious and requires emergency treatment.
Symptoms of ectopic pregnancy usually include dizziness,nausea,light vaginal bleeding,abdominal cramps etc.
iv) Implantation bleeds
Some women experience bleeding at the time the fertilized egg implants into the uterus.Thus it’s the first signs of a typical pregnancy.Some women experience implantation bleeding while others never do. Implantation bleeding is normal and nothing serious to be worried about. Often occurs at or around the time of the expected period, so it can be confused with a light period.