When To Be Concerned About Having Two Periods In A Month
Prolonged Periods: A Cause for Concern?
A long period probably sounds like a nuisance to anyone, but for some women, it could indicate a serious problem.
By Melanie Winderlich
Medically Reviewed by Pat F. Bass III, MD, MPH
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For some women, time seems to move at a glacial pace during their menstrual periods — especially if they’re experiencing prolonged menstrual bleeding.
Doctors consider normal menstrual bleeding a period that lasts from three to seven days; prolonged menstrual bleeding, or menorrhagia, is defined as bleeding that goes beyond a week. Depending on the circumstances, long menstruation may be a condition that can be easily controlled with birth control hormones or one that indicates a serious underlying health issue.
The length of an average menstrual cycle for an adult woman lasts anywhere between 21 and 35 days. Younger girls just entering puberty and older women approaching menopause might notice that their periods follow irregular patterns, either lasting shorter or longer than normal or perhaps with a flow that becomes heavier or lighter.
Usually, these irregularities occur because of changes in hormone levels, especially estrogen. Estrogen helps build up the uterine lining, called the endometrium, which will either house a fertilized egg or become most of what is shed during a menstrual period. While irregular menstrual periods can be bothersome, these hormonal changes are common and rarely mean something more serious.
Causes of Prolonged Menstrual Bleeding
You may hear your doctor use certain medical terms when referring to irregular or prolonged menstrual bleeding. Menorrhagia describes a period that is very heavy or long lasting. Polymenorrhea refers to irregular bleeding for spans of 21 days or less. These are abnormal conditions identified after other causes, like pregnancy, have been ruled out.
Dysfunctional uterine bleeding (DUB) is another cause of prolonged menstruation. DUB can happen at any time during a woman's reproductive years, but most commonly affects those over age 40. DUB indicates a hormone dysfunction, which can impact the uterine lining’s stability and lead to irregular, heavy, or prolonged menstrual bleeding.
Doctors treat DUB with hormones: estrogen, progesterone, or a combination of the two female hormones in the form of birth control pills. Besides being used as contraception, birth control pills can regulate hormone production and impact how the uterine lining grows. Birth control pills may even help treat DUB for women entering perimenopause, the stage right before menopause.
Some hormone-based birth control can impact frequency, duration, and flow levels of menstrual periods. Also, changing the type or brand of birth control you use can influence menstrual bleeding. However, you should never alter your birth control strategy on your own initiative or treat your prolonged menstruation based on how a friend with similar symptoms was treated: Every woman's menstrual cycle is different, and a host of medical issues can affect periods.
Underlying Conditions That Cause Prolonged Menstrual Bleeding
A visit with your gynecologist or other health care professional is the first step in determining the cause of your prolonged menstrual bleeding. Your doctor will make a diagnosis after performing a series of tests.
Depending on your age, your doctor may test your blood for pregnancy, hormone levels, and thyroid function. Other diagnostic tests and procedures may include pap smears, endometrial biopsies, and ultrasounds.
Medical conditions that could be the cause of abnormal menstrual bleeding include:
- Uterine fibroids, non-cancerous growths of the uterus wall
- Endometrial hyperplasia, a thickened endometrium
- A bleeding disorder, like von Willebrand disease
- Problems with clotting
- Thyroid functioning
- Glandular issues
- Ovarian cysts
- Uterine polyps
Problems with ovulation can also impact a period’s length.
Treatments for Prolonged Menstrual Bleeding
Besides birth control, treatments for abnormal menstrual bleeding include:
- Hysterectomy, the surgical removal of the uterus
- Endometrial ablation, the surgical removal or burning of the uterine lining
The right course of treatment depends on the cause of your prolonged menstrual bleeding and your personal circumstances, such as whether you want to become pregnant in the future. Certain procedures, like a hysterectomy, will cause infertility.
Prolonged menstrual bleeding may just be part of a bothersome pattern for some women or a sign of a medical condition that should be addressed. If something doesn't feel right to you, always ask your doctor, and keep a detailed account of your menstrual bleeding in order to provide your doctor with another piece of the diagnostic puzzle.
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