Possible Causes
The most common cause of irregular or heavy bleeding is irregular ovulation. If there is no ovulation your period may be late and when it comes it may last a long time or be unusually heavy. Irregular ovulation is more common if you are underweight or very overweight. If you are overweight, this increases your risk of heavy and irregular periods. If this goes on for many years it may increase your risk of uterine cancer later in life. If you are overweight you may benefit from a low-sugar, low-calorie diet, weight loss and exercise for at least 30 minutes per day.
The combination of excessive exercising – particularly running – and very low body weight increases your risk of anovulation. If this goes on for a long period of time you may increase your risk of osteoporosis. If you are underweight regular menses may resume if you maintain a normal body weight and limit exercise to 30 minutes a day.
Irregular and heavy periods can be successfully treated with hormonal therapy in the setting of overweight, underweight or normal weight women.
Heavy and irregular bleeding may also be the result of an abnormal pregnancy. A miscarriage or a pregnancy outside of the uterus may cause abnormal or heavy bleeding.
Heavy and irregular bleeding may also be the result of benign tumors of the uterus such as fibroid tumors or endometrial polyps. These may require surgical removal.
A malfunctioning thyroid gland can cause heavy or absent periods. Thyroid abnormalities are easily treated medically. Elevated prolactin may cause absent or irregular bleeding. An abnormal prolactin level can be the result of a microscopic tumor that produces this hormone. This may be medically or surgically treated.
Heavy and irregular bleeding may also be the result of gonorrhea and chlamydia infections. These are readily treated with antibiotics.
Abnormal bleeding may also be caused by cancerous or pre-cancerous conditions of the cervix or uterus. The earlier they are diagnosed the easier they are to treat.
Endometriosis can cause heavy periods as well as pelvic pain.
Evaluation
Heavy and/or irregular bleeding in a young woman requires a complete medical and menstrual history as well as a complete physical exam. A complete list of medications is important. Blood tests should be performed for anemia, thyroid disease, pregnancy and prolactin level. Sometimes more hormonal tests are necessary to rule out other rare causes of absent or erratic periods. A cervical culture for infections like gonorrhea or chlamydia and a Pap smear may need to be done. An endometrial biopsy or a D&C diagnose pre-cancerous and cancerous lesions of the uterus. Ultrasound may be needed to look for uterine or ovarian tumors that are too small to be felt on an examination. If periods and/or intercourse are painful, a laparoscopy may be needed to diagnose endometriosis.
Treatment
Treatment depends on what cause for the irregular or heavy bleeding was found. It also matters what your plans for a future family are. If there is no obvious cause, there are many options including birth control pills, injectable hormones, the Mirena® IUD, endometrial ablation, and uterine artery embolization.
If you are actively trying to get pregnant, taking Naproxen Sodium (Aleve®) during your period can make them lighter and less painful. If your periods are irregular and heavy due to polycystic ovarian syndrome there is medication available to make your periods more regular and lighter. If you are not trying to get pregnant there are other options. Depo-Provera® is a long-acting injectable hormone that stops your periods and provides birth control for 3 months. The Mirena IUD is an intrauterine device containing a small amount of hormone that gives you lighter periods and provides birth control for up to 5 years. Endometrial ablation is a procedure for women who are done with childbearing that cauterizes the inside of the uterus to give you lighter periods. Uterine artery embolization is a procedure done at the hospital by an interventional radiologist that reduces blood flow to the uterus and makes fibroids smaller. It is also recommended only for women done with childbearing. If you are done with childbearing and all other treatments have failed or are not for you, there is hysterectomy. A hysterectomy can often be done through the vagina or by laparoscopy with the da Vinci® Robot, making it less painful and shortening hospitalization.
If you have heavy and irregular periods there is help available. Don’t restrict your life to suit your periods. Let us help you control your periods to suit your life.