Sometimes your period comes right on time every month and generally lasts around five days. Other times, you have unpredictable bleeding or even heavy menstrual bleeding. This can be frustrating and difficult to plan out certain activities — nobody likes a surprise, an unexpected visit from Aunt Flo among them. Many women experience abnormal uterine bleeding at some point, and it’s often not because of a serious problem. It is a good idea, however, to see your primary care doctor or gynecologist if you notice changes in your period.
First, let’s talk about what’s considered a normal period. There’s still wide variability in women’s menstrual cycles. A normal period can be a 21-day up to a 35-day cycle. Bleeding typically lasts five days, but it can be anywhere from four to seven days.
Now that you know what’s expected, let’s take a closer look at what’s not so normal. Changes in your menstrual cycle or bleeding tend to signal that something else is going on in your body. Abnormal uterine bleeding can include:
- Heavy menstrual bleeding: This is defined as blood loss greater than 80 mL (or about a 1/3 cup). You would notice that you’re going through more pads or tampons than normal.
- Bleeding between periods: You may have bleeding or spotting between your actual period.
- Irregular periods: Your period may be spaced out more than normal or happen closer together. You may bleed for longer than you’re used to as well.
- Bleeding after sex: During or after being intimate, you may notice blood.
“In a woman’s lifetime, it is common to have an occassional irregular cycle,” said Ambareen Jan, MD, a gynecologist with Lahey Hospital & Medical Center in Burlington. “You want to see a doctor if the bleeding has gotten heavier or more unpredictable and is interfering with your daily life. Any bleeding after menopause needs further investigation.”
What Causes Abnormal Uterine Bleeding?
There can be many causes of abnormal bleeding, but the most frequent reasons include:
- Problems with ovulation, specifically not ovulating
- Fibroids or polyps
- Birth control complications
- Adenomyosis, a problem in which the tissue that lines the uterus invade the muscle layer
- Bleeding disorders
“Anovulatory bleeding, or not ovulating, is the most common cause, however we always want to rule out an abnormal pregnancy in reproductive-age women,” Dr. Jan said.
She said that peri-menopausal women who have abnormal bleeding often have erratic ovulation which causes irregular and unpredictable periods. Your hormones change at stages in your life, which can change what’s “normal” for your period.
What Can Be Done?
Bleeding between periods, painful periods or bleeding after sex should warrant a doctor’s visit. Changes in the bleeding amount, frequency or duration of your periods are also good to have checked out by a gynecologist or primary care doctor.
He or she will evaluate you and possibly order blood tests to rule out certain conditions, like pregnancy or cancer. Birth control is the most common treatment to regulate your hormones and help you establish a normal cycle. Your doctor can recommend a type of birth control, whether a pill, intrauterine device or another method that works best for your lifestyle.
Abnormal bleeding can be difficult to deal with and interfere with your daily life. Building a relationship with a gynecologist is a good way to stay healthy and manage any changes to your period. Your doctor at Lahey can uncover and treat the cause to help you feel normal again.