Menstrual Disorders

With heavy menstrual periods (also called menorrhagia), your bleeding may be heavier or last longer than normal. You may:

• Pass large blood clots and soak through your pads or tampons often.
• Bleed for more than 7 days.
• Have menstrual cramps.

Heavy periods may disrupt your life. But in most cases, they aren't a sign of a serious problem.

Still, it's a good idea to see your doctor. A doctor can suggest treatments to ease your symptoms and make sure that you don't have a serious condition.

A number of things can cause heavy periods. These include:

• Irregular ovulation. Normally, one of your ovaries releases an egg during your menstrual cycle. This is called ovulation.
• If you don't ovulate, this can affect the lining in your uterus and may cause heavy bleeding.
• A growth in the uterus, such as a polyp or fibroid
• Adenomyosis
• This condition occurs when the cells that normally line the uterus grow into the wall of the uterus.
• Some bleeding disorders that prevent blood from clotting properly.
• A copper IUD.
• Certain medicines, such as anticoagulants

Sometimes a cause can't be found.

In rare cases, heavy periods may be a sign of a serious problem, such as an infection or cancer.

Your doctor will ask about your menstrual periods and do a pelvic exam During the exam, your doctor will check for signs of disease, infection, and abnormal growths.

If needed, your doctor may also do one or more tests to find out what's causing heavy periods. These tests may include:

• A fluid sample from your cervix or vagina. This can look for signs of infection.
• A Pap or HPV test. This screens for cervical cancer.
• Blood tests. These can check for anemia, a bleeding disorder, or other problems.
• A pelvic ultrasound. This test can look for any problems in the pelvic area.
• An endometrial biopsy
• It can check for abnormal cell changes in the lining of the uterus (endometrium).
• A hysteroscopy. This can check the lining of your uterus to look for the cause of bleeding, such as fibroids.

In most cases, heavy menstrual periods can be managed with medicines or hormone treatments. If those treatments don't help, you may need surgery to help control your bleeding.

Your doctor may suggest that you take a nonsteroidal anti-inflammatory drug (NSAID), like ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve). Taking an NSAID can reduce bleeding and pain during your period. But NSAIDs usually don't help as much as hormone treatments.

Hormone treatments that may be prescribed include:

• Birth control pills, patch, or ring. These release two hormones, estrogen and progestin. They prevent pregnancy and also can reduce menstrual bleeding and pain.
• Progestin-only birth control, such as mini-pills, implants, and shots. These types of birth control can reduce bleeding and cramping.
• Progestin pills. These are progestin-only pills that help reduce bleeding but do not prevent pregnancy.
• Hormonal IUD. This is a birth control device that your doctor places inside your uterus. It releases a type of progestin that can reduce bleeding and cramping.

Sometimes doctors prescribe a medicine called tranexamic acid (such as Lysteda). It is not a hormone treatment. It reduces bleeding by helping blood to clot.

You may want to think about surgery if medicines don't help or if you have a growth in your uterus. Your choice will depend partly on whether you want to get pregnant in the future. Surgery options include:

• Hysteroscopy. This procedure is done to diagnose heavy periods. But it can also treat some problems at the same time. For example, fibroids or polyps may be removed during this procedure.
• Endometrial ablation. This procedure destroys the endometrium. This reduces or stops uterine bleeding. But it is not an option if you hope to get pregnant.
• Hysterectomy, a surgery to remove the uterus. This may be an option if heavy bleeding can't be controlled or when the cause of bleeding can't be found and treated. It ends your ability to get pregnant.

If you have cramps during your periods, ask your doctor about taking an NSAID such as ibuprofen or naproxen. It can help with cramps and reduce menstrual bleeding. An NSAID works best when you start taking it 1 to 2 days before you expect pain to start. If you don't know when your period will start next, take your first dose as soon as bleeding or cramping starts.

Heavy periods can make you feel weak and tired and can lead to anemia. Your doctor may suggest that you take an iron supplement if your iron levels are low. You may be able to prevent anemia if you increase the amount of iron in your diet. Foods rich in iron include red meat, shellfish, eggs, and beans.

Menstrual periods often occur every 21 to 35 days. But you may be different. Missed or irregular periods must be looked at in terms of what is normal for you. Menstrual periods often aren't regular during the first few years after your period starts. It may take several years for the hormones that control menstruation to reach a balance.

Periods also may not be regular when you get closer to perimenopause and menopause.

Menopause occurs when it has been 12 months since you had a period. Pregnancy is the most common cause of a missed period. If you might be pregnant, treat yourself as if you are pregnant until you know for sure. Use a home pregnancy test as the first step to find out if you are pregnant.

If you aren't pregnant, other causes of missed or irregular periods include:

• Excessive weight loss or gain. Low body weight is a common cause of missed or irregular periods. Obesity also can cause menstrual problems.
• Eating disorders, such as anorexia or bulimia
• Increased exercise. Missed periods are common in endurance athletes.
• Emotional stress.
• Chronic diseases, such as diabetes or irritable bowel syndrome.
• Medicines such as birth control methods. These may cause lighter, less frequent, more frequent, or skipped periods or no periods at all.
• Hormone problems, such as polycystic ovary syndrome. They may cause a change in the levels of the hormones that the body needs to support menstruation.
• Illegal drug use.
• Problems with the pelvic organs, such as an imperforate hymen, or Asherman's syndrome
• Breastfeeding. Regular periods may not resume until after you have finished breastfeeding.
• Primary ovarian insufficiency. This means you stop having periods before age 40. It can be caused by surgery, chemotherapy, or radiation therapy to the belly or pelvis.

Remember, you can still become pregnant even though you don't have periods. Practice birth control if you don't wish to become pregnant.

If you've skipped a period, try not to worry. It isn't uncommon to miss periods now and then. Unless you're pregnant, your cycle likely will return to normal next month.