Guide | Do Not Ignore Abnormal Periods: These Signs May Indicate a More Serious Gynecologic Condition
"My period is here," "that time of the month again," "the red light is on"—menstruation has many nicknames and may bring painful cramps, heavy bleeding, prolonged periods, and irregular cycles. Sometimes these are minor disruptions, but at other times they may be warning signs.
Which menstrual changes are normal variations, and which warrant attention or prompt medical care? A medical team interviewed several obstetricians and gynecologists to outline practical criteria.
What Menstrual Patterns Are Considered Normal?
Jonathan Scher, clinical associate professor of obstetrics and gynecology at Mount Sinai Medical Center in New York, said menstrual irregularity may be physiological during three life stages:
1. Soon after the first period during puberty
2. The first few periods after miscarriage, induced abortion, or childbirth
3. The transition before menopause, usually in the late 40s to early 50s
Ovulation is often irregular during these stages, so variation in period length and flow may be normal. During the reproductive years, however, periods arriving more than a week early or late, a marked increase or decrease in flow, severe menstrual pain, or irregular bleeding between periods, including spotting, should be assessed promptly.
Menstrual Pain May Require More Than Endurance
Severe menstrual pain or heavy bleeding may indicate endometriosis. In this condition, tissue similar to the uterine lining grows in abnormal locations such as the ovaries, fallopian tubes, or near the rectum, causing chronic inflammation and adhesions that may ultimately affect fertility.
Beth, age 56, is one example. "During my 40s, my periods became so heavy that I was almost trapped in the bathroom," she recalled. Her periods lasted 8 to 10 days, while her cycle shortened from 28 to 21 days. "I became weaker and weaker." She was eventually diagnosed with endometriosis.
Dr. Richard C. Roberson, a family physician in Athens, Georgia, explained that endometriosis is diagnosed through laparoscopy. Mild cases may be managed with nonsteroidal anti-inflammatory drugs such as ibuprofen or oral contraceptives. Severe cases may require surgery, and hysterectomy may sometimes be considered.
Persistent Spotting May Be Caused by Uterine Polyps
Linda Murray, a 32-year-old woman in San Francisco, was troubled by feeling as though she was menstruating almost every day. The irregular light bleeding was ultimately diagnosed as uterine polyps.
Uterine polyps are benign growths of endometrial tissue, possibly caused by hormonal fluctuations, and often present as spotting between periods. Linda recalled: "I had to wear a liner every day and could not tell whether it was actually my period." A simple procedure resolved the problem.
Uterine Fibroids Can Also Change Menstrual Patterns
Uterine fibroids are among the most common benign tumors in women in their 30s and 40s and are a leading reason for hysterectomy. They may grow in response to estrogen, prolong periods, increase bleeding, and sometimes affect fertility.
Dr. Roberson said fibroids that do not cause pain, anemia, or other symptoms may be monitored, particularly as menopause approaches, because they often shrink as hormone levels fall. Younger women planning pregnancy may consider uterus-preserving surgery such as myomectomy.
Hysterectomy Is Not a Universal Solution
After several attempts at treatment, Beth chose hysterectomy. "I first had a dilation and curettage (D&C), but it did not help much. My doctor later recommended removing the uterus. After surgery, my quality of life improved substantially and my energy returned."
Experts caution that hysterectomy is not appropriate for everyone. Patients should discuss the benefits and risks fully with their physician before deciding.
Most Menstrual Abnormalities Are Treatable
Dr. Roberson emphasized: "Menstrual abnormalities are common, but the good news is that most causes are benign and many can be treated with medication or minimally invasive surgery."
If your periods become early, late, prolonged, or accompanied by spotting between cycles, do not simply endure it. Discuss the changes with a physician.
Guide | Do Not Ignore Abnormal Periods: These Signs May Indicate a More Serious Gynecologic Condition
Guide | Do Not Ignore Abnormal Periods: These Signs May Indicate a More Serious Gynecologic Condition
"My period is here," "that time of the month again," "the red light is on"—menstruation has many nicknames and may bring painful cramps, heavy bleeding, prolonged periods, and irregular cycles. Sometimes these are minor disruptions, but at other times they may be warning signs.
Which menstrual changes are normal variations, and which warrant attention or prompt medical care? A medical team interviewed several obstetricians and gynecologists to outline practical criteria.
What Menstrual Patterns Are Considered Normal?
Jonathan Scher, clinical associate professor of obstetrics and gynecology at Mount Sinai Medical Center in New York, said menstrual irregularity may be physiological during three life stages:
1. Soon after the first period during puberty
2. The first few periods after miscarriage, induced abortion, or childbirth
3. The transition before menopause, usually in the late 40s to early 50s
Ovulation is often irregular during these stages, so variation in period length and flow may be normal. During the reproductive years, however, periods arriving more than a week early or late, a marked increase or decrease in flow, severe menstrual pain, or irregular bleeding between periods, including spotting, should be assessed promptly.
Menstrual Pain May Require More Than Endurance
Severe menstrual pain or heavy bleeding may indicate endometriosis. In this condition, tissue similar to the uterine lining grows in abnormal locations such as the ovaries, fallopian tubes, or near the rectum, causing chronic inflammation and adhesions that may ultimately affect fertility.
Beth, age 56, is one example. "During my 40s, my periods became so heavy that I was almost trapped in the bathroom," she recalled. Her periods lasted 8 to 10 days, while her cycle shortened from 28 to 21 days. "I became weaker and weaker." She was eventually diagnosed with endometriosis.
Dr. Richard C. Roberson, a family physician in Athens, Georgia, explained that endometriosis is diagnosed through laparoscopy. Mild cases may be managed with nonsteroidal anti-inflammatory drugs such as ibuprofen or oral contraceptives. Severe cases may require surgery, and hysterectomy may sometimes be considered.
Persistent Spotting May Be Caused by Uterine Polyps
Linda Murray, a 32-year-old woman in San Francisco, was troubled by feeling as though she was menstruating almost every day. The irregular light bleeding was ultimately diagnosed as uterine polyps.
Uterine polyps are benign growths of endometrial tissue, possibly caused by hormonal fluctuations, and often present as spotting between periods. Linda recalled: "I had to wear a liner every day and could not tell whether it was actually my period." A simple procedure resolved the problem.
Uterine Fibroids Can Also Change Menstrual Patterns
Uterine fibroids are among the most common benign tumors in women in their 30s and 40s and are a leading reason for hysterectomy. They may grow in response to estrogen, prolong periods, increase bleeding, and sometimes affect fertility.
Dr. Roberson said fibroids that do not cause pain, anemia, or other symptoms may be monitored, particularly as menopause approaches, because they often shrink as hormone levels fall. Younger women planning pregnancy may consider uterus-preserving surgery such as myomectomy.
Hysterectomy Is Not a Universal Solution
After several attempts at treatment, Beth chose hysterectomy. "I first had a dilation and curettage (D&C), but it did not help much. My doctor later recommended removing the uterus. After surgery, my quality of life improved substantially and my energy returned."
Experts caution that hysterectomy is not appropriate for everyone. Patients should discuss the benefits and risks fully with their physician before deciding.
Most Menstrual Abnormalities Are Treatable
Dr. Roberson emphasized: "Menstrual abnormalities are common, but the good news is that most causes are benign and many can be treated with medication or minimally invasive surgery."
If your periods become early, late, prolonged, or accompanied by spotting between cycles, do not simply endure it. Discuss the changes with a physician.
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Collected online