What is abnormal menstruation?

Most women have menstrual periods that last four to seven days. A woman's period usually
occurs every 28 days, but normal menstrual cycles can range from 21 days to 35 days.

Examples of menstrual problems include:

● Periods that occur less than 21 days or more than 35 days apart
● Missing three or more periods in a row
● Menstrual flow that is much heavier or lighter than usual
● Periods that last longer than seven days
● Periods that are accompanied by pain, cramping, nausea or vomiting
● Bleeding or spotting that happens between periods, after menopause or following sex

Examples of abnormal menstruation include the following:

● Amenorrhea is a condition in which a woman’s periods have stopped completely. The

absence of a period for 90 days or more is considered abnormal unless a woman is
pregnant, breastfeeding, or going through menopause (which generally occurs for
women between ages 45 and 55). Young women who haven't started menstruating by
age 15 or 16 or within three years after their breasts begin to develop are also
considered to have amenorrhea.
● Oligomenorrhea refers to periods that occur infrequently.
● Dysmenorrhea refers to painful periods and severe menstrual cramps. Some discomfort
during the cycle is normal for most women.
● Abnormal uterine bleeding may apply to a variety of menstrual irregularities, including: a
heavier menstrual flow; a period that lasts longer than seven days; or bleeding or
spotting between periods, after sex, or after menopause.

What causes abnormal menstruation (periods)?

There are many causes of abnormal periods, ranging from stress to more serious underlying
medical conditions:

● Stress and lifestyle factors. Gaining or losing a significant amount of weight, dieting,
changes in exercise routines, travel, illness, or other disruptions in a woman's daily
routine can have an impact on her menstrual cycle.
● Birth control pills. Most birth control pills contain a combination of the hormones estrogen
and progestin (some contain progestin alone). The pills prevent pregnancy by keeping
the ovaries from releasing eggs. Going on or off birth control pills can affect
menstruation. Some women have irregular or missed periods for up to six months after
discontinuing birth control pills. This is an important consideration when you are planning
on conception and becoming pregnant. Women who take birth control pills that contain
progestin only may have bleeding between periods.
● Uterine polyps or fibroids. Uterine polyps are small benign (noncancerous) growths in
the lining of the uterus. Uterine fibroids are tumors that attach to the wall of the uterus.
 There may be one or several fibroids that range from as small as an apple seed to the
size of a grapefruit. These tumors are usually benign, but they may cause heavy
bleeding and pain during periods. If the fibroids are large, they might put pressure on the
bladder or rectum, causing discomfort.
● Endometriosis. The endometrial tissue that lines the uterus breaks down every month
and is discharged with the menstrual flow. Endometriosis occurs when the endometrial
tissue starts to grow outside the uterus. Often, the endometrial tissue attaches itself to
the ovaries or fallopian tubes; it sometimes grows on the intestines or other organs in the
lower digestive tract and in the area between your rectum and uterus. Endometriosis
may cause abnormal bleeding, cramps or pain before and during periods, and painful
intercourse.
● Pelvic inflammatory disease. Pelvic inflammatory disease (PID) is a bacterial infection
that affects the female reproductive system. Bacteria may enter the vagina via sexual
contact and then spread to the uterus and upper genital tract. Bacteria might also enter
the reproductive tract via gynecologic procedures or through childbirth, miscarriage, or
abortion. Symptoms of PID include a heavy vaginal discharge with an unpleasant odor,
irregular periods, pain in the pelvic and lower abdominal areas, fever, nausea, vomiting,
or diarrhea.
● Polycystic ovary syndrome. In polycystic ovary syndrome (PCOS), the ovaries make
large amounts of androgens, which are male hormones. Small fluid-filled sacs (cysts)
may form in the ovaries. These can often been seen on an ultrasound. The hormonal
changes can prevent eggs from maturing, and so ovulation may not take place
consistently. Sometimes a woman with polycystic ovary syndrome will have irregular
periods or stop menstruating completely. In addition, the condition is associated with
obesity, infertility and hirsutism (excessive hair growth and acne). This condition may be
caused by a hormonal imbalance, although the exact cause is unknown. Treatment of
PCOS depends on whether a woman desires pregnancy. If pregnancy is not a goal, then
weight loss, oral contraceptive pills, and the medication Metformin® (an insulin sensitizer
used in diabetes) can regulate a woman’s cycles. If pregnancy is desired, ovulation-
stimulating medications can be tried.
● Premature ovarian insufficiency. This condition occurs in women under age 40 whose
ovaries do not function normally. The menstrual cycle stops, similar to menopause. This
can occur in patients who are being treated for cancer with chemotherapy and radiation,
or if you have a family history of premature ovarian insufficiency or certain chromosomal
abnormalities. If this condition occurs, see your physician.

Other causes of abnormal menstruation include:

● Uterine cancer or cervical cancer.

● Medications, such as steroids or anticoagulant drugs (blood thinners).
● Medical conditions, such as bleeding disorders, an under- or overactive thyroid gland, or
pituitary disorders that affect hormonal balance.
● Complications associated with pregnancy, including miscarriage or an ectopic pregnancy
(the fertilized egg is implanted outside the uterus; for example, within the fallopian tube).
How is abnormal menstruation (periods) diagnosed?
If any aspect of your menstrual cycle has changed, you should keep an accurate record of when
your period begins and ends, including the amount of flow and whether you pass large blood
clots. Keep track of any other symptoms, such as bleeding between periods and menstrual
cramps or pain.

Your doctor will ask you about your menstrual cycle and medical history. He or she will perform
a physical examination, including a pelvic exam and sometimes a Pap test. The doctor might
also order certain tests, including the following:

● Blood tests to rule out anemia or other medical disorders.

● Vaginal cultures, to look for infections.
● A pelvic ultrasound exam to check for uterine fibroids, polyps or an ovarian cyst.
● An endometrial biopsy, in which a sample of tissue is removed from the lining of the
uterus, to diagnose endometriosis, hormonal imbalance, or cancerous cells.
Endometriosis or other conditions may also be diagnosed using a procedure called a
laparoscopy, in which the doctor makes a tiny incision in the abdomen and then inserts a
thin tube with a light attached to view the uterus and ovaries.

How is abnormal menstruation (periods) treated?

The treatment of abnormal menstruation depends on the underlying cause:

● Regulation of the menstrual cycle: Hormones such as estrogen or progestin might be

prescribed to help control heavy bleeding.
● Pain control: Mild to moderate pain or cramps might be lessened by taking an over-the-
counter pain reliever, such as ibuprofen or acetaminophen. Aspirin is not recommended
because it might cause heavier bleeding. Taking a warm bath or shower or using a
heating pad might help to relieve cramps.
● Uterine fibroids: These can be treated medically and/or surgically. Initially, most fibroids
that are causing mild symptoms can be treated with over-the-counter pain relievers. If
you experience heavy bleeding, an iron supplement might be helpful in preventing or
treating anemia. Low-dose birth control pills or progestin injections (Depo-Provera®)
may help to control heavy bleeding caused by fibroids. Drugs called gonadotropin-
releasing hormone agonists may be used to shrink the size of the fibroids and control
heavy bleeding. These drugs reduce the body’s production of estrogen and stop
menstruation for a while. If fibroids do not respond to medication, there are a variety of
surgical options that can remove them or lessen their size and symptoms. The type of
procedure will depend on the size, type and location of the fibroids. A myomectomy is
the simple removal of a fibroid. In severe cases where the fibroids are large or cause
heavy bleeding or pain, a hysterectomy might be necessary. During a hysterectomy, the
fibroids are removed along with the uterus. Other options include uterine artery
embolization, which cuts off the blood supply to the active fibroid tissue.
 ● Endometriosis: Although there is no cure for endometriosis, over-the-counter or
prescription pain relievers may help to lessen the discomfort. Hormone treatments such
as birth control pills may help prevent overgrowth of uterine tissue and reduce the
amount of blood loss during periods. In more severe cases, a gonadotropin-releasing
hormone agonist or progestin may be used to temporarily stop menstrual periods. In
severe cases, surgery may be necessary to remove excess endometrial tissue growing
in the pelvis or abdomen. A hysterectomy might be required as a last resort if the uterus
has been severely damaged.

There are other procedural options which can help heavy menstrual bleeding. A five-year
contraceptive intrauterine device (IUD), called Mirena®, has been approved to help lessen
bleeding, and can be as effective as surgical procedures such as endometrial ablation. This is
inserted in the doctor’s office with minimal discomfort, and also offers contraception.
Endometrial ablation is another option. It uses heat or electrocautery to destroy the lining of the
uterus. It is usually only used when other therapies have been tried and failed. This is because
scars from the procedure can make monitoring the uterus more difficult if bleeding persists in
the future.

How can the risk of abnormal menstruation (periods) be reduced?

Here are some recommendations for self-care:

● Try to maintain a healthy lifestyle by exercising moderately and eating nutritious foods. If
you have to lose weight, do so gradually instead of turning to diets that drastically limit
your calorie and food intake.
● Make sure you get enough rest.
● Practice stress reduction and relaxation techniques.
● If you are an athlete, cut back on prolonged or intense exercise routines. Excessive
sports activities can cause irregular periods.
● Use birth control pills or other contraceptive methods as directed.
● Change your tampons or sanitary napkins approximately every four to six hours to avoid
toxic shock syndrome and prevent infections.
● See a doctor for regular check-ups.

When should you seek medical attention for abnormal menstruation (periods)?
Contact a doctor or medical professional if you have any of the following symptoms:

● Severe pain during your period or between periods

● Unusually heavy bleeding (soaking through a sanitary pad or tampon every hour for two
to three hours) or passing large clots
● An abnormal or foul-smelling vaginal discharge
● High fever
● A period lasting longer than seven days
● Vaginal bleeding or spotting between periods or after you have gone through
menopause
 ● Periods that become very irregular after you have had regular menstrual cycles
● Nausea or vomiting during your period
● Symptoms of toxic shock syndrome, such as a fever over 102 degrees, vomiting,
diarrhea, fainting or dizziness

You should also see a doctor if you think you might be pregnant.

Source:
1. “Abnormal Menstruation (Periods): Types, Causes & Treatment.” Cleveland Clinic, 2019,
my.clevelandclinic.org/health/diseases/14633-abnormal-menstruation-periods.