Abnormal Periods
What is a normal cycle?
The normal length of the menstrual cycle is typically between 24 days and 38 days. A normal menstrual period generally lasts up to 8 days.
When is bleeding abnormal?
Bleeding in any of the following situations is considered abnormal uterine bleeding:
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Bleeding or spotting between periods
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Bleeding or spotting after sex
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Heavy bleeding during your period
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Menstrual cycles that are longer than 38 days or shorter than 24 days
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“Irregular” periods in which cycle length varies by more than 7–9 days
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Bleeding after menopause
Hormonal imbalance
Hormonal imbalance can cause irregular period bleeding.
Lifestyle influences hormones in a big way. If you have a hormonal imbalance, this does not mean your ovaries don't know how to produce hormones adequately.
Consider how your body responds to hormones:
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How your body processes hormones.
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How your body metabolizes hormones.
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How your body eliminates and detoxifies hormones.
If you have issues with those steps (production issues, metabolism issues, or elimination issues), then you're gonna have symptoms of hormonal imbalance.
Some women are estrogen deficient. Some have too much estrogen. Some women are estrogen deficient one month and estrogen dominant the next. This is especially common in women going through the menopausal transition.
With estrogen overload, you may experience heavy, faucet-like bleeding and lots of cramping.
When you are on the deficient side you get hot flashes, night sweats, vaginal dryness or painful intercourse because the vagina is very sensitive to declines in estrogen. You can start noticing things like loss of libido or more difficulty with orgasm. Depression and anxiety occur as well.
As progesterone declines, you may also notice some of these symptoms, including depression, anxiety, and heart palpations.
So that's where lifestyle factors are critical. Stress, sleep, nutrition, exercise.
Other causes of irregular bleeding
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Bleeding disorders
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Cancer of the uterus, cervix, ovaries, or fallopian tubes
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Thyroid disease
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Gut, Liver, & Kidney disease
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Inflammatory disorders
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Adrenal disorders
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Medications like aspirin and blood thinners
How is abnormal bleeding diagnosed?
It may be helpful to keep track of your menstrual cycle before your visit. Note the dates, length, and type (light, medium, heavy, or spotting) of your bleeding on a calendar. You can also use a smartphone app designed to track menstrual cycles. Flo is a great app for this.
You will have a physical exam. You may also have blood tests. These tests check your blood count and hormone levels and rule out some diseases of the blood. You may also have a pregnancy test and tests for sexually transmitted infections (STIs).
What tests may be needed to diagnose abnormal bleeding?
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Ultrasound exam (or sonogram)—Sound waves are used to take a picture of the pelvic organs.
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Hysteroscopy—A thin, lighted scope is inserted through the vagina and the opening of the cervix. It allows your ob-gyn or other health care professional to see the inside of the uterus.
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Endometrial biopsy—A sample of the endometrium is removed and looked at under a microscope.
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Sonohysterography—Fluid is placed in the uterus through a thin tube while ultrasound images are made of the inside of the uterus.
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Magnetic resonance imaging (MRI)—An MRI exam uses a strong magnetic field and sound waves to create images of the internal organs. There is no tradition from this test.
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Computed tomography (CT)—This shows internal organs and structures in cross-section.
What medications help control abnormal bleeding?
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Hormonal birth control methods—Birth control pills, the patch, the shot, and the vaginal ring contain hormones. These hormones can lighten menstrual flow.
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Gonadotropin-releasing hormone (GnRH) agonists or antagonists —Oriahnn and Myfembree can stop the menstrual cycle and reduce the size of fibroids.
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Tranexamic acid—This medication treats heavy menstrual bleeding. Tranexamic acid or TXA is an antifibrinolytic agent. It works by blocking the breakdown of blood clots, which prevents bleeding.
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Antibiotics—If you have an infection, you may be given an antibiotic.
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NSAIDs --- Like Naproxen, Mefenamic acid, and even Ibuprofen can lighten your bleeding and control pain at the same time.
What supplements help control abnormal bleeding?
When adrenal imbalance is the cause of bleeding:
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Licorice Root (no more than 100mg daily)
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DHEA: the “anti-aging” hormone because it converts into estrogen and testosterone, contributing to overall hormonal balance.
Support liver function so that it can break down and clear extra estrogen:
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DIM Detox — Supports breakdown of estrogen and promotes hormone balance.
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Dandelion Root (500-1575mg daily)
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Milk Thistle (125-250mg, 1-4 times daily between meals)
BONUS:
Seed cycling may relieve some of your symptoms if a hormonal imbalance is present. Seed cycling is not really new, but it is newly trendy for the management of abnormal periods.
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What types of surgery are performed to treat abnormal bleeding?
Endometrial ablation with NovaSure destroys the lining of the uterus. It stops or reduces the total amount of bleeding. Pregnancy is not likely after ablation, but it can happen. If it does, the risk of serious complications, including life-threatening bleeding, is greatly increased. If you have this procedure, you will need to use birth control until after menopause.
Uterine artery embolization is a procedure used to treat fibroids. This procedure blocks the blood vessels to the uterus, which in turn stops the blood flow that fibroids need to grow. Another treatment, myomectomy, removes the fibroids but not the uterus.
Hysterectomy, the surgical removal of the uterus, is used to treat some conditions or when other treatments have failed. Hysterectomy also is used to treat endometrial cancer. After the uterus is removed, a woman can no longer get pregnant and will no longer have periods.
