Symptom of Endometriosis: Abnormal Menstrual Bleeding

The average menstrual cycle lasts roughly 28 days; however, many experts agree that a cycle that lasts anywhere between 21 and 35 days is still considered typical. In contrast, cycles that occur in less than 21 day intervals or longer than 35 day intervals are considered abnormal. Menstrual bleeding may also be considered abnormal if it is significantly lighter or heavier than normal, or if a woman experiences bleeding between periods or post-menopause. Periods with bleeding that lasts longer than seven days are also considered examples of abnormal menstrual bleeding, as well as bleeding following sex.^1,2

A woman is said to experience amenorrhea when her period seems to stop all together for at least three periods in a row, and oligomenorrhea when her periods are still occurring, but are infrequent. When a woman experiences very heavy bleeding or has a period that is longer than a week, it is called menorrhagia.^1,4 It is normal to experience minor irregularities in the menstrual cycle or menstrual bleeding when a woman is first experiencing menstruation or when she is approaching menopause, however, abnormal menstrual bleeding outside of this window may be indicative of an underlying issue.

Causes of abnormal menstrual bleeding

Many factors can contribute to abnormal menstrual bleeding, including the following:

• Gynecological conditions such as endometriosis, pelvic inflammatory disease (PID), uterine polyps or fibroids, polycystic ovary syndrome (PCOS), adenomyosis, premature ovarian insufficiency, or cancers of the uterus or cervix
• Hormonal imbalances or hormone-affecting conditions
• Medications including birth control pills or steroids
• Bleeding disorders
• Thyroid conditions
• Stress
• Intrauterine devices (IUD)
• Significant weight changes
• Intense exercise habits
• Diet
• Eating disorders^1-4

Evaluation

Evaluating abnormal menstrual bleeding can be challenging, as a main focus is to determine the underlying cause of the abnormal bleeding among many similarly presenting conditions. In order to do this, your doctor will take full medical history from you, including information on your menstrual cycles, any medications you are currently taking, pregnancy status, past medical conditions, and more. Once your doctor receives a complete personal medical history from you, they may be able to start narrowing down the list of potential causes. Subsequent exams and diagnostic tests such as blood work, a Pap smear, endometrial biopsy, imaging exams such as an ultrasound or CT scan, or hysteroscopy (where a thin, lighted, camera-containing device is used to view the inside of the uterus) may be performed, among other potential diagnostic tests.^1,2,4

Treatment options

Treatment of abnormal menstrual bleeding may depend on what the underlying issue contributing to the bleeding is. If no definitive cause is found, there are some broad treatment options that may be utilized. Some examples of potential treatment options for abnormal menstrual bleeding include:

• Nonsteroidal anti-inflammatory medications
• Hormonal birth control methods such as birth control pills or a hormonal IUD
• Medications called GnRH (gonadotropin-releasing hormone) agonists
• Antibiotic medications if an infection is present
• Other condition-specific medications, such as drugs for bleeding disorders
• Surgery in rare cases where a surgical procedure may help treat the underlying condition including hysterectomy, uterine artery embolization, or endometrial ablation^2,3

Additional management options

Managing abnormal menstrual bleeding outside of some of these outlined treatment options may include increasing preparedness efforts, such as always packing extra pads, tampons, or a change of underwear or clothing during a heavy period. It may also be helpful to keep these supplies on hand even when you are not on your period, especially if you regularly experience bleeding between periods. It's important to talk with your doctor or healthcare team if abnormal menstrual bleeding impacts your ability to perform your normal daily activities or activities you enjoy. They may be able to recommend options for you to try in order to still perform your regular routine.

Abnormal menstrual bleeding may also cause feelings of fear, especially of having a period-related accident or a surprise episode of bleeding. These feelings may impact a woman's mental health as well. If you or a loved one are experiencing mental distress as a result of your abnormal menstrual bleeding, consider seeking professional support such as counseling or a support group.