Problem Periods

Too heavy…too frequent…skipped altogether? There are solutions.

At best they’re an inconvenience, but sometimes menstrual periods are cause for more serious concern. Absent or skipped periods, or periods that are too frequent or heavy, can stem from many different causes and should be evaluated, says Joseph Patruno, M.D., gynecologist at Lehigh Valley Hospital and Health Network.

First, what’s normal? It varies with the individual, but most women menstruate every 21-35 days, Patruno says. Heavier periods are common in the teens when hormones are fluctuating, and women in their late 30s or 40s often have heavy or irregular periods as they approach menopause.

“If you have heavy periods, a pain reliever like ibuprofen or naproxen can help decrease cramps and bleeding. But if periods become especially heavy, last more than seven days or cause anemia, or if you have bowel or bladder problems, see your doctor,” Patruno says. Vaginal bleeding in girls under age 10 or in women past menopause should always be evaluated by a doctor.

Heavy periods often are hormone-related, and birth control pills, injectable hormones like Depo-Provera or a progesterone-containing intrauterine device (IUD) can help stabilize the condition. Thyroid disorders are another possible cause of heavy or irregular periods, and these usually can be treated easily with medication.

If the heavy periods are caused by growths—fibroids or endometrial polyps—they usually can be removed with small incisions and quick recovery. This may involve placing a laparoscope in the abdomen or a hysteroscope into the uterus. “We have many alternatives to hysterectomy (removing the uterus) now, although it is still sometimes appropriate,” Patruno says. “Even hysterectomies can be done laparoscopically today, for less pain and a quicker recovery.”

Since heavy bleeding can be caused by cervical or uterine cancer, a biopsy may be necessary to rule that out. Another study commonly ordered in the evaluation of abnormal bleeding is an ultrasound of the pelvis.

On the flip side are absent or missed periods. This problem may stem from lifestyle factors such as substance abuse, stress, travel and excessive exercise. Eating disorders and major weight changes also can cause altered periods. And menstruation can be affected by medications, chemotherapy or radiation therapy.

Diseases that disrupt the timing of the menstrual cycle include polycystic ovary syndrome, adrenal disease, ovarian cysts, pituitary disease, HIV/AIDS, diabetes, liver disease and certain cancers.

“Your doctor will do a thorough workup to find the underlying cause, but don’t panic. It’s not unusual to miss or have an atypical period now and then,” Patruno says. “It is always important to eat a balanced diet, exercise regularly and keep stress in check. If you don’t wish to get pregnant, a number of birth control methods offer the added benefit of regulating your periods.”

Want to Know More about painful cramps, endometriosis and other factors that affect fertility? Click on the links in the column on the right of this page.

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