Many Solutions for a Common Problem
Menstruation means shedding the lining of the uterus approximately every four weeks in non-pregnant women. There is a huge variation in “normal” menstrual periods. Cycles are different from person to person and can change from year to year in the same woman. Occasionally, abnormal changes can cause concern, discomfort, inconvenience and embarrassment. There are several ways to manage these problems, including medications and surgical options.
The amount of menstrual flow varies from woman to woman. It is often hard to know if one's own experience is within normal limits. The best way to describe the severity of your flow is to describe the time it takes to soak a pad (side to side and front to back) or a tampon.
What is abnormal?
Abnormal menstruation occurs when cycles are either too frequent or too scarce, flow is long, flow is heavy or there is bleeding between periods. The normal cycle ranges from 21 to 35 days, with an average of 28 days. If an occasional cycle is shorter or longer, this does not necessarily mean there is an abnormality. If many of your cycles fall outside this range, tell your gynecologist and bring a calendar of your cycles with you. Your gynecologist will take a history, complete a physical examination and may order some blood tests to examine blood counts and hormone levels.
Another form of abnormal menstruation occurs when there is excessive blood flow. Heavy flow or prolonged flow (longer than seven days per cycle) can lead to anemia and can make completion of daily responsibilities difficult or even impossible. Once again, it is helpful to keep a calendar of dates and to take this to your appointment. A history, physical exam, blood tests and possibly a biopsy or an ultrasound exam will help us determine the cause of heavy or prolonged bleeding.
Some ways to manage abnormal bleeding (depending on the cause) include non-steroidal anti-inflammatories (e.g., ibuprofen and naproxen). These medications can reduce the volume of flow for some women. Another non-hormonal medication is appropriate for some women. Another option is oral contraceptives, a good choice for women who also need birth control. An intrauterine contraceptive device can also help with the management of abnormal bleeding.
Surgical options include endometrial ablation and hysterectomy. Endometrial ablation is the destruction of the uterine lining so it cannot regenerate each month. We perform endometrial ablation in an outpatient setting. We use hysterectomy only when there are no other options or the other options have been exhausted with no relief.
Abnormal menstruation occurs on occasion for many women but when the abnormality is severe or persists for more than a cycle or two, tell your gynecologist. The extent of your gynecologist’s investigation and treatment will depend on the information you share. You may just need reassurance of the normal variation in cycles or there may be a need for some testing and management. Many individual conditions may be discovered during the investigation and our recommendations will vary depending on the findings and the individual.
Discover what you need to know about abnormal bleeding at Capital Women’s Care Howard County. Call 410-531-7557 or use our online Request an Appointment form to make an appointment. Our abnormal-bleeding patients come to us from Columbia, Ellicott City, Fulton, Laurel and Maple Lawn in Howard County, Maryland and adjacent areas.