Heavy, Prolonged, or Irregular Menstrual Periods

Menstrual periods that are heavy, prolonged, or irregular are abnormal. There are many possible causes for an abnormal period. These include:

• hormonal imbalances
• growths in the ovaries or uterus
• irregular growth of the uterine lining
• cancer (rare)
• blood disorders (rare)

If your periods cause you excessive pain or discomfort, talk to your doctor. An OB-GYN or other women’s health practitioner may be able to help.

Menstrual cycles vary among women. The average length of the menstrual cycle is 28 days. Most women’s cycles range from 24 to 34 days. Bleeding should last between four and seven days.

Heavy or Prolonged Menstruation

Heavy menstruation is also called menorrhagia. It is characterized by very heavy bleeding that may last longer than seven days. Menorrhagia is diagnosed only if bleeding disrupts your daily life.

Irregular Menstruation

Irregular menstruation can be categorized as:

• Amenorrhea: lack of menstruation. Women are expected to start bleeding by the age of 16.
• Oligomenorrhea: infrequent periods
• Dysmenorrhea: painful cramping during periods

Many women expect their periods to be painful. However, excess pain can be the sign of an underlying medical problem.

Menorrhagia

There are several possible causes of a heavy or prolonged menstrual period.

• Hormone imbalance. The hormones estrogen and progesterone regulate a woman’s menstrual cycle. If the two are imbalanced, the lining of the uterus may build up too much. This can lead to excessive bleeding.
• Uterine fibroids. These benign uterine tumors are fairly common during the childbearing years.
• Dysfunctional ovaries. If the ovaries do not release an egg, no progesterone is released. This leads to a hormonal imbalance.
• Intrauterine device (IUD). Using this type of birth control can cause excessive bleeding. IUDs that release hormones are less likely to cause this side effect. They may even stop periods altogether.
• Adenomyosis. This condition occurs when the endometrium (the lining of the uterus) gets embedded in the muscle of the uterus. It is most common in women who have had children.
• Complications of pregnancy. A miscarriage can accompany a very heavy period. Heavy bleeding can also result from an ectopic pregnancy. An ectopic pregnancy occurs when the egg implants in the fallopian tube rather than in the uterus.

There are a few other causes of menorrhagia, but they are uncommon. These include:

• cancer in the uterus, ovaries, or cervix
• rare bleeding disorders, such as von Willebrand’s disease
• pelvic inflammatory disease
• kidney disease
• thyroid disorders

Amenhorrea

One common reason that women start their periods late is that their body fat percentage is very low. This affects the production of hormones. Other reasons for delayed periods include:

• regular exercise
• eating disorders, such as anorexia
• tumors
• hormonal problems, such as polycystic ovary syndrome
• stress

Oligomenorrhea

The hormonal imbalance caused by polycystic ovary syndrome (PCOS) is likely to cause oligomenorrhea. PCOS results in the production of high levels of androgen hormones, such as testosterone. This can lead to infrequent periods.

Prolonged use of hormonal birth control can also cause absent or irregular periods.

Dysmenorrhea

Very painful periods can be caused by:

• ovarian cysts
• infection
• endometriosis

Endometriosis is a condition where the tissues that should be inside the uterus grow on the outside.

There are many possible causes of abnormal periods. Because some are serious, you should talk to your doctor about any concerns. This is particularly true if your periods disrupt your life.

See your doctor right away if you:

• soak through a tampon or pad in two to three hours
• menstruate for more than one week
• have severe pain during menstruation
• bleed between periods or after menopause
• think you could be pregnant

When you see your doctor about abnormal menstruation, you can expect to be given a physical examination, including a pelvic exam. Your doctor will also ask you a series of questions about your period, menstrual cycle, and accompanying symptoms. You will need to tell your doctor about all medications and supplements you are taking.

In addition to the questions and physical exam, your doctor may need to order diagnostic tests. You may need a Pap smear. This takes a sample of cells from your cervix to look for abnormalities. You may also have a piece of lining of the uterus removed for examination. This is known as an endometrial biopsy.

For a better look at your uterus and ovaries, your doctor may perform an ultrasound. This technique uses sound waves to create an image of your internal organs. You may also need to have blood drawn for tests to detect a hormonal imbalance.

To help your doctor determine the cause of your abnormal menstruation, keep a diary at home. Record:

• when your periods start and stop
• how heavy your flow is
• if you bleed between periods
• other symptoms you experience

You can keep this diary in paper form. There are also smart phone and computer applications to help make menstrual tracking easier.

To relieve pain, avoid the use of aspirin. It can make bleeding worse. Ibuprofen lessens pain and may even reduce blood loss. Applying heat to the abdomen can also reduce the pain of severe cramps.