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Menstrual periods - heavy, prolonged, or irregularPage Content: Irregular menstruation; heavy, prolonged, or irregular periods; menorrhagia; polymenorrhea; metrorrhagiaConsiderations The menstrual cycle is not the same for every woman. On average, menstrual flow occurs every 28 days (with most women having cycles between 24 and 34 days), and lasts about 4 days. However, there is wide variation in timing and duration that is still considered normal, especially if your periods began within the last few years. If you soak through a sanitary pad or tampon every hour for 6 consecutive hours, this is considered a very heavy period. A prolonged period is one that lasts longer than 7 days. A small percentage of women have periods more often than every 21 days or less often than every 35 days. These variations may be normal. Bleeding may be something to worry about if it occurs between periods, after intercourse, or if you are over age 50, especially if you have already gone through menopause. The risk of cancer increases with age. Often, if you are bleeding from the rectum or there is blood in your urine, you may think the blood is coming from the vagina. To know for certain, insert a tampon into the vagina to confirm that it's the source of your bleeding. Common Causes
Home Care Keep a record of your menstrual cycles, including when menstruation begins and ends, how much flow you have (count numbers of pads and tampons used, noting whether they are soaked), and any other symptoms you experience. Tampons should be changed at least twice a day to avoid infection. Because aspirin may prolong bleeding, it should be avoided. Ibuprofen is usually more effective than aspirin for relieving menstrual cramps. Call your health care provider if Call your doctor if:
What to expect at your health care provider's office Your doctor will perform a physical examination, including a pelvic exam. Your doctor will ask questions like the following to determine the history of this symptom:
Diagnostic tests that may be performed include:
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. If a tumor is found, surgery (a hysterectomy ) will sometimes be needed. "Fibroid" tumors (uterine fibroids ) are common and are not related to cancer. Fibroids may stop growing by themselves, and surgery may not be needed depending on the amount of bleeding, the location of the fibroid, and the response to various treatment attempts. Fibroids often stop growing at menopause, so an operation can be avoided by waiting. However, if there has been rapid growth of the fibroid tumor or if your Pap smear is abnormal, surgery or another 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. References Osei J, Critchley H. Menorrhagia, mechanisms and targeted therapies. Curr Opin Obstet Gynecol. 2005; 17(4): 411-418. James AH. More than menorrhagia: a review of the obstetric and gynaecological manifestations of bleeding disorders. Haemophilia. 2005; 11(4): 295-307. Warner PE, Critchley HO, Lumsden MA, Campbell-Brown M, Douglas A, Murray GD. Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods: a survey with follow-up data. Am J Obstet Gynecol. 2005; 192(6): 2093-2095. Illustrations
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