When Your Period Is More Like An Exclamation or Question Mark!?
For most women the monthly period has been a part of life, albeit annoying and most of the time an inconvenient part. Since your very first period started as a young girl where you may have thought you were bleeding to death, or worse - becoming a woman, you may have battled with trying to understand what this cycle means. Hopefully we’ll try to answer some of those questions and make sense out of that mysterious menstrual cycle.
The menstrual cycle isn't the same for every woman. Normal menstrual flow occurs every 21 to 35 days, lasts four to five days and produces a total blood loss of 30 to 40 milliliters (about 2 to 3 tablespoons). Your period may be regular or irregular, light or heavy, painful or pain-free, long or short and still be considered normal. Menorrhagia refers to losing 80 milliliters or more of blood during your menstrual cycle. Anything outside of this may be considered abnormal bleeding or dysfunctional bleeding.
Sometimes women experience several months of normal cycles and suddenly miss a period for a month or two then have it recur again but with only spotting before it becomes “normal”. This could be a sign of either hormonal dysregulation or other pathology that your OBGYN should evaluate.
The signs and symptoms of menorrhagia may include:
- Menstrual flow that soaks through one or more sanitary pads or tampons every hour for several consecutive hours
- The need to use double sanitary protection to control your menstrual flow
- The need to change sanitary protection during the night
- Menstrual periods lasting longer than seven days
- Menstrual flow that includes large blood clots
- Heavy menstrual flow that interferes with your regular lifestyle
- Constant pain in your lower abdomen during menstrual periods
- Tiredness, fatigue or shortness of breath (symptoms of anemia)
When you experience a heavy period or one that lasts longer than 7 days, several things need to ruled out, first and foremost is pregnancy. Following that, any pre-cancerous or cancerous source of the bleeding, this can be ruled out by your OBGYN with an in-office endometrial biopsy. Finally if the biopsy proves that you do not have a cancerous source and that the lining is responding normally to hormonal stimulation, then an anatomic source of the bleeding needs to be ruled out, such as a polyp or fibroid. A polyp or fibroid is an overgrowth of benign smooth muscle or tissue. There is a difference between a polyp and a fibroid and your doctor can explain this more to you in detail. Your OBGYN can perform a specialized ultrasound in the office to determine if you have a polyp or a fibroid; sometimes a CT scan or MRI may be necessary to determine the location and size of some fibroids.
For some women, there is no obvious source of their irregular cycles and for these women hormonal birth control in the form of birth control pills, may help. In some cases depending on your age and social situation a hormone based Intrauterine device (IUD) or a vaginal ring can be placed which may help alleviate heavy periods or help make them more regular.
For some women in which hormone based products would not be considered safe - risk factors include 35 years or age or older, smoker, history of coronary heart disease, personal history of breast cancer, or personal or family history of blood clots. These women if they have completed child bearing may consider a procedure known as endometrial ablation. This is a procedure which can be done safely in the office and with very little sedation. It is a process in which the lining of the uterus is ablated with a heat source and is essentially scarred down. In about 70% of the cases these patients will have no more bleeding, for the remaining 30% of women they may have relief from bleeding for up to 3-4 years but unfortunately it can recur. For these women, a hysterectomy may be the best option.
For those women who have had somewhat regular to irregular cycles and then suddenly it stops. If you are done with child bearing, you may be relived, however for those of you that are not done; you may be concerned if that there is something else going on. The first thing again your doctor will need to rule out is pregnancy. If you are not pregnant, your doctor will have to decide how to best evaluate you. Sometimes, if your cycles are irregular you may not ovulate (release an egg) which can make it more difficult for you to get pregnant. Your OBGYN can give you certain medications that can bring on a period and even help you ovulate. In most cases these methods work well, in some cases however, further evaluation and treatment may be necessary.
The physicians at Women’s Health and Surgery Center perform all the procedures described above in the Stafford, Virginia office and we perform hysterectomies by either minimally invasive laparoscopic (small incisions) or vaginal approaches. In most cases our patients are sent home the same day or the next morning with either method. This is fast becoming standard of care for the surgical management of these patients and we are pleased to provide this to our patients.