What’s normal and what’s not when it comes to your period.
Normal menstrual (period) cycles occur every 21 to 36 days, and typically last for 3 to 7 days. Patterns that fall outside this range are usually considered abnormal. Abnormal menstrual bleeding, excessive bleeding, and abnormal menstrual cycles are fairly common, and occasional irregularities are generally of no consequence. Persistent abnormal bleeding, including excessive bleeding, can signal disease, result in anemia and fatigue, and negatively impact quality of life.
Up to one-third of all outpatient gynecologic visits are for abnormal menstrual bleeding. We often hear the question, “What does abnormal menstrual bleeding mean?” Abnormal bleeding can result from growths within the uterus, such as fibroids or polyps, both of which are typically benign. It can also result from overgrowth of the lining, called hyperplasia, which can often be precancerous. Uterine cancer can cause abnormal bleeding, particularly bleeding after menopause.
Polyps or fibroids within the lining of the uterus can usually be removed during an outpatient hysteroscopic procedure. What is a hysteroscopy? During this procedure, a slender telescope with camera at the end is inserted into the vagina and through the cervix to visualize the inside of the uterus. The polyp or fibroid is then removed with a small wire loop or a tiny rotating blade called a morcellator. In rare cases when tissue obtained through endometrial biopsy or hysteroscopy reveal cancer, we refer to a gynecologic oncologist (cancer specialist) who uses minimally invasive surgical techniques.
For women who do not have uterine abnormalities, abnormal menstrual bleeding is most often related to hormonal imbalances. Thyroid disorders are one such cause of abnormal bleeding that can be diagnosed and treated effectively. Often women who do not ovulate regularly experience irregular and heavy bleeding. For many women, oral contraceptives can be used to provide steady female hormone levels and produce a thin uterine lining, resulting in less bleeding. Intrauterine devices (IUDs) containing a low dose of a progestin can also minimize bleeding and create very light periods. The Mirena® and Skyla® intrauterine systems (IUS) are two such IUDs. Both deliver a low dose of a progestin hormone directly to the lining of the uterus and so they have minimal systemic effects. The Mirena® IUS can be left in place for 5 years while the Skyla® IUS last for 3 years.
When medical treatment is not acceptable or does not work, endometrial ablation often yields very good results. Endometrial ablation is also done through the hysteroscope as an outpatient procedure. We can often do these procedures in our office treatment room rather than in a hospital operating room, resulting in convenience as well a significant cost savings to the patient. Much of the uterine lining is burned away so that it cannot regenerate every month to produce heavy bleeding. Most women experience a marked reduction in their menstrual blood loss and some women have no further bleeding at all. Because the fetus relies on nourishment from the uterine lining during growth and development, this procedure is reserved only for women who do plan to bear children in the future.
Some women choose the definitive surgical option, hysterectomy, in order to guarantee no further problems with bleeding. We perform a minimally invasive hysterectomy through the laparoscope, total laparoscopic hysterectomy. Women can choose to have their ovaries removed or retained at surgery.
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