Options available for abnormal menstrual cycles

Painful or abnormally heavy menstrual cycles can occur at any age of a woman’s life. However, symptoms can be worse for premenopausal women, mainly in their 30s and 40s.

According to the National Institutes of Health, heavy menstrual bleeding is one of the most common gynecologic disorders affecting women of reproductive age. It accounts for up to one-third of gynecologic office visits and is the leading cause of hysterectomies in the US. A normal menstrual cycle is 24 to 38 days.

A normal menstrual period typically lasts up to eight days. According to the American College of Obstetricians and Gynecologists (ACOG), abnormal uterine bleeding is defined as heaving bleeding during a monthly period, bleeding or spotting between periods or after sex, or bleeding after menopause.

Abnormal bleeding can be caused by a hormonal imbalance, fibroids and polyps, bleeding disorders, miscarriage, uterine cancer, or other unknown causes. When abnormal bleeding is a concern, an OB/ GYN or other healthcare provider will conduct a physical exam and review the patient’s health history and menstrual cycles. As part of the diagnosis, a blood test may be ordered and any of the following tests performed:

• Ultrasound exam—Sound waves are used to make a picture of the pelvic organs.
• Hysteroscopy—A thin, lighted scope is inserted through the vagina to see inside the uterus.
• Endometrial biopsy—A sample of the endometrium (inner lining of the uterus) is removed and viewed under a microscope.

Treatment options for irregular or heavy menstrual bleeding include medications and surgery. Medications often are tried first and include the following:

• Hormonal management—birth control pills or birth control injections (DepoProvera) can lighten menstrual flow and make periods more regular.
• Tranexamic acid—treats heavy menstrual bleeding.
• Nonsteroidal anti-inflammatory drugs—ibuprofen and others may help control heavy bleeding and relieve menstrual cramps.
• Antibiotics—they are used to treat an infection.
• Mirena IUD—this government-approved intrauterine device treats heavy periods and provides birth control. If medications are not effective, the following surgical options are available:
• Dilation and curettage (D&C)— involves removing the uterine lining.
• Endometrial ablation—destroys a thin lining of the uterus with no surgical incisions. Menstrual bleeds continue, but are reduced to normal or lighter levels.
• Uterine artery embolization—the procedure blocks blood vessels to the uterus that fibroids need to grow.
• Hysterectomy—removal of the uterus.

If heavy menstrual bleeding is a concern, the ACOG recommends women keep track of their menstrual cycle before visiting their OB/GYN. Noting the dates, length, and type (light, medium, heavy, or spotting) can help with diagnosis and treatment.