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Medical Encyclopedia

Encyclopedia -> Symptoms -> M -> Menstrual periods - abnormal

Menstrual periods - abnormal

Alternate Names: Periods - heavy or prolonged; Menorrhagia

Considerations:

The menstrual cycle is not the same for every woman. Normal menstrual flow occurs about every 28 days, lasts about 5 days, and produces a total blood loss of 60 to 250 milliliters (2 tablespoons to about 1 cup). Periods may be regular, irregular, light, heavy, painful, pain-free, long, or short, and still be normal. Variation in the menstrual cycle is medically less significant than bleeding, pain, or discharge between periods.

Bleeding may be something to worry about for women over age 50 (postmenopausal) or younger than age 12 (prepubertal). The risk of malignancy increases with age.

Make sure that bleeding is coming from the vagina and not from the rectum or in the urine. This can be accomplished by inserting a tampon into the vagina to confirm that the vagina is the source of the bleeding. A serious problem can best be detected by a health care provider.

Common Causes:

  • anovulation (failure of ovaries to produce, mature, or release eggs)
  • endometrial polyps
  • endometrial hyperplasia and cancers
  • uterine fibroids
  • abnormal thyroid or pituitary function

Home Care:

Bed rest may be recommended if bleeding is heavy.

The number of pads or tampons used should be recorded (so that the doctor can determine the amount of bleeding). Change tampons regularly, at least twice a day.

Because aspirin may prolong bleeding, it should be avoided if possible. For menstrual cramps, use ibuprofen (for example, Advil or Nuprin). Ibuprofen is usually more effective than aspirin for relieving menstrual cramps.

If you use an IUD for birth control, slight spotting is normal. If no other symptoms are present, the spotting is probably insignificant.

Call If:

  • you have severe pain, or if periods have been heavy and recurrent over 3 or more months.
  • you have bleeding after menopause.
  • you have abnormal bleeding accompanied by other symptoms.
  • you have severe pain that does not respond to home treatment.

What To Expect:

The medical history will be obtained and a physical examination performed.

Medical history questions documenting abnormal menstrual periods in detail may include:

  • menstrual history
    • Are you a woman presently in a menstruating age group?
    • Was the previous menstrual period a normal amount?
    • Do you use tampons?
    • Do you normally have regular periods?
    • quality
      • Has there been passage of blood clots?
      • How long per menstrual period is the bleeding?
      • How heavy is it?
    • time pattern
      • When was the last menstrual period?
      • What was the age at which you had your first menstrual period?
      • How long have you had the same menses pattern?
    • aggravating factors
      • Do you use birth control pills?
      • Do you take an estrogen supplement?
      • Do you use an IUD for birth control?
      • Do you take aspirin more than once per week?
      • Do you take Coumadin, heparin, or other anticoagulant?
      • Has there been a recent childbirth, surgery on or near the vagina or uterus, vaginal infection, uterine infection, or other possible source of trauma to the vagina or uterus?
    • other

    The physical examination may include a pelvic examination if the patient is in the premenstrual phase of the menstrual cycle (particularly if endometriosis is suspected). Uterine blood loss can be estimated if the patient knows how many sanitary napkins or tampons were used during a period.

    Diagnostic tests that may be performed include:

    Intervention:
    Ibuprofen or another prostaglandin inhibitor is often prescribed. Ibuprofen is also available in lower dosages (Advil, Nuprin) without prescription.

    In some cases of heavy bleeding, dilation and curettage ("D and C") may be required. A hysterectomy may not be performed if having difficult periods is the only complaint.

    If a tumor is found, surgery will sometimes be needed, but the common "fibroid" tumor (uterine fibroids) will often stop growing by itself, and surgery may not be needed depending on the amount of bleeding and the response to various treatment attempts. Such tumors often grow slowly and stop growing completely at the menopause, so an operation can be avoided by waiting. However, if the Pap smear is positive, surgery or other type of therapy may be necessary.

    If the heavy bleeding is related to hormonal abnormalities, treatment of the specific abnormality will correct the bleeding. Female hormones (birth control pills or progestins) are commonly used to regulate menses.

    After seeing your health care provider:
    If a diagnosis was made by your health care provider related to abnormal menstrual periods, you may want to note that diagnosis in your personal medical record.

    Disclaimer: The text presented on these pages is for your information only. It is not a substitute for professional medical advice. It may not represent your true individual medical situation. Do not use this information to diagnose or treat a health problem or disease without consulting a qualified health care provider. Please consult your health care provider if you have any questions or concerns.

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