That Time of the Month
By Cathleen F. Crowley/HealthyLife
At age 41, Jennifer’s period became erratic. One month was heavy, the next was light, and there was bleeding in between.
Jennifer, a medical transcriptionist from Latham, talked to her doctors, had a few tests and learned nothing was wrong. “Then it went away,” she says.
Normal is hard to define when it comes to periods. Some women bleed long and heavy. Others breeze through each cycle.
“There is a wide range of what is normal,” says Dr. Mary Joyce McGinnis, of McGinnis Women’s Medical Care in Albany.
Menstruation is the regular shedding of the uterine lining. Every month, a woman’s body prepares for pregnancy. If no pregnancy occurs, the uterus casts off its lining and the blood and tissue are expelled.
Periods usually start around age 12 and continue to menopause around age 50. On average, a woman’s period occurs every 28 days but normal cycles range from 24 to 34 days, according to the National Institutes of Health. Most periods last 3 to 5 days, but anywhere from two to seven days is normal.
Between 9 percent and 14 percent of women of childbearing age have irregular menstrual cycles or excessively heavy menstrual bleeding, according to the NIH.
How do you know when something is wrong? Gynecologists say talk to a doctor about anything that deviates from your normal cycle or anything that concerns you.
Here are some of the common problems that send women to the doctor:
My period is heavy
It looks much worse, but experts say women lose only two to three tablespoons of blood, according to the Centers for Disease Control and Prevention. Women with heavy flow may lose twice as much blood and may develop anemia.
A technique that helps measure is tracking how many tampons or pads you use. Generally speaking, soaking through a tampon or pad every hour for two to three hours in a row is considered excessive.
“If you have a lady who bleeds so heavily she misses work, or has to take two sets of clothes to work or doesn’t leave the house for two days, it is a lifestyle thing but it is also not normal,” McGinnis says. “In today’s world, it’s going to be difficult for somebody to hold a job or function in the world if they are constrained by how much they are bleeding.”
Excessive bleeding can be a sign of sexually transmitted infections and ovulatory disorders and can be a risk factor of endometrial cancer.
Most cases of heavy bleeding are not caused by an underlying problem, however; it’s just how your body works. The good news is treatments do exist that can help control it.
“I think most doctors actually take it more seriously than patients do,” McGinnis says. “I get the attitude from patients who say ‘My mother said she bled like this.’ But it’s 2013, not 1913.”
My period is irregular
Timing is everything. Cycles that are shorter than three weeks or longer than six weeks are worth talking to a doctor about, especially if you’ve previously been as regular as the lunar cycle.
Spotting and mid-cycle bleeding also can be signs of a problem. Hormonal changes, excessive exercise, stress, and of course, pregnancy, can cause changes in a woman’s cycle.
Gynecologists recommend keeping a calendar of when your period starts and There’s an app for that, too.
“I have had patients who have come in with spreadsheets of every period they have had their entire life from the age of 12 and it’s been 25 years,” McGinnis says. “That is a little obsessive, but it can be helpful for people to record the first day of a period.”
My period hurts
Some discomfort is normal during a period, but severe pain is not. Pain is more common among teenagers and young women during the early years of menstruation.
Pain that develops later in a woman’s life may be related to something more serious such as endometriosis, infection or fibroids.
About 30 to 40 percent of women have fibroids — an overgrowth of the uterine muscle — says Dr. Melody Bruce, an OB/Gyn with Community Care Physicians in Clifton Park and Troy. “They are almost always benign,” Bruce says.
If you feel pain, check with your doctor.
What are those chunks?
Blood clots are completely normal during a period. They occur when blood flows slower and has time to coagulate before being expelled.
A sudden appearance of a large number or size of clots is worth mentioning to a doctor, but otherwise, they are nothing to worry about.
“It’s not a sign that you are hemorrhaging,” Bruce says.
It is blood doing what it is supposed to do. Hemorrhaging, however, appears as bright red blood that soaks through pads quickly and runs down the legs. It requires immediate attention.
Oh, it’s just perimenopause
After age 40, a woman’s menstrual cycle becomes less regular as her hormones shift and start to shut down reproduction. This process, called perimenopause, can last two to eight years until periods stop entirely.
It is common for periods to become lighter and less frequent during perimenopause.
“I have numerous ladies in their 40 to 55 age range that are bleeding continuously, bleeding heavily, bleeding through their clothes who tell me, ‘Oh, it’s just part of menopause. I didn’t worry about it,’” McGinnis says. “Frequently, what they are telling me would not be normal — ever.”
It should be investigated.
I’m bleeding after menopause
A woman is officially in menopause one year after her last period.
“After menopause, you should not bleed,” McGinnis says. Most bleeding is benign, but it can be a sign of uterine cancer. Get it checked out.
Talk to your doctor about your concerns.
“There’s a new focus on getting women to understand that there is more to gynecological care than the pap smear,” McGinnis says. “If you’ve had a pap smear (that is normal) it doesn’t mean you ignore abnormal bleeding.”
In 2011, the International Federation of Gynecologists and Obstetricians released a classification system that places abnormal bleeding into nine basic categories. Previously, the nomenclature was confusing and inconsistent. The new system helps doctors diagnose and treat abnormal bleeding.
Your gynecologist may order tests such as a pelvic ultrasound, endometrial biopsy, hysteroscopy (a scope to view the uterine cavity) or a sonohysterogram (another type of ultrasound).
Women today have many options for dealing with abnormal bleeding from birth control pills, IUDs, medications that staunch the flow on heavy days or minor surgery.
“There are so many treatments now for abnormal bleeding, or excessive bleeding, that the number of hysterectomies in this country has been dropping steadily for years because we no longer just have to take out somebody’s uterus,” McGinnis says.
The vast majority of problems are not serious. “It could be be nothing, or it could be something,” says Jennifer, the medical transcriptionist.
It’s worth a chat with your doctor.
See your doctor about your period if:
Your period suddenly stops for more than 90 days.
Your periods become very irregular after having had regular, monthly cycles.
Your period occurs more often than every 21 days or less often than every 35 days.
You are bleeding for more than seven days.
You bleed between periods.
You have severe pain during your period.
You are bleeding more heavily than usual or using more than one pad or tampon every one to two hours.
You suddenly get a fever and feel sick after using tampons.
You bleed after menopause.
Source: U.S. Department of Health and Human Services Office on Women’s Health
Stages of menopause
Perimenopause: This is the time leading up to a woman’s last period. Periods can stop and then start again, so you are in perimenopause until a year has passed since you’ve had a period. During perimenopause a woman will have changes in her levels of estrogen and progesterone, two female hormones made in the ovaries. These changes may lead to symptoms such as hot flashes, night sweats, pounding heart, skin flushing, sleeping problems, and periods that occur less often. Other symptoms include mood swings, vaginal dryness, trouble focusing, headaches, less sex drive, joint aches and less hair on the head and more on the face. There is no way to tell in advance how long it will take you to go through the menopausal transition, but it generally takes two to eight years.
Menopause: This is the time in a woman’s life when her period stops. It usually occurs naturally, most often after age 45. Menopause happens because a woman’s ovary stops producing the hormones estrogen and progesterone. A woman has reached menopause when she has not had a period for one year. Changes and symptoms can start several years earlier.
Postmenopause: The period after menopause when female hormones no longer go up and down the way they used to during the menstruation cycle. They will stay at very low levels. Postmenopausal women cannot get pregnant.
Source: National Institutes of Health and U.S. Department of Health and Human Services Office on Women’s Health