Irregular or heavy periods are common and can affect women at any age. Irregular periods may come too often, too far apart, or skip months. Heavy periods may last longer than usual or involve heavier flow. These symptoms can interfere with daily activities and may sometimes lead to low iron or anemia.
Symptoms
- Periods that do not follow a regular monthly pattern
- Bleeding lasting longer than seven days
- Needing to change pads or tampons very frequently (for example, hourly)
- Waking at night to change protection
- Passing large blood clots
- Cramping or pelvic discomfort
- Tiredness, weakness, dizziness, or shortness of breath
Possible Causes
There are many possible reasons for irregular or heavy bleeding. These may include:
- Changes in hormones or ovulation
- Uterine fibroids or uterine polyps
- Adenomyosis (uterine lining growing into the uterine muscle)
- Thyroid conditions
- Blood-clotting or bleeding disorders
- Certain medications such as blood thinners
- Endometriosis or pelvic inflammatory disease
- Perimenopause
- Pregnancy-related causes
- Rarely, precancerous or cancerous changes in the uterus
Sometimes, more than one factor is involved.
Evaluation
During your visit, we will review your medical history and menstrual pattern and perform a pelvic examination. Depending on your symptoms, additional tests may include:
- Pelvic ultrasound to evaluate the uterus and ovaries
- Blood tests to assess iron levels, hormones, and thyroid function
- A Pap test, if due
- Endometrial biopsy to evaluate the uterine lining (recommended in certain cases, especially over age 40)
- Hysteroscopy, which uses a small camera to look inside the uterus and remove small growths if needed
Treatment Options
Treatment is personalized based on your symptoms, test results, age, and whether you plan to become pregnant in the future. Options may include:
- Iron supplementation if iron levels are low
- Medication to reduce menstrual flow and cramping
- Hormonal medications to regulate or lighten menstrual bleeding
- Hormonal intrauterine device (IUD), which can significantly reduce or stop periods
- A non-hormonal medication taken only during your period to reduce bleeding
Procedural and Surgical Options
If medications are not effective or suitable, procedures may be recommended:
- Hysteroscopy to remove polyps or treat abnormalities inside the uterus
- Dilation and curettage (D&C), which temporarily reduces bleeding
- Endometrial ablation or endometrial resection to thin or remove the uterine lining (not recommended if future pregnancy is desired)
- Hysterectomy, which is the removal of the uterus and ends menstrual periods permanently
Fertility Considerations
Some procedures, such as ablation, or hysterectomy, are not appropriate for women who wish to become pregnant in the future. It is important to discuss family planning goals before choosing a treatment approach.
