How to Manage Menstrual Irregularities
November/December 2016
Typical menstrual cycles last between 23 and 35 days and include seven or fewer days of bleeding (usually with a few days of light fl ow or spotting at the beginning and end and a day or two of heavy bleeding in the middle). In general, cramping shouldn’t affect your ability to perform daily activities 
and should be easily relieved with over-the-counter medications such as ibuprofen.
If your period tends to last more than a week, your cycle is irregular and unpredictable and/or there is heavy bleeding or significant pain associated with that time of the month, you are not alone. Abnormal menstrual bleeding is common among women of all ages – from puberty to menopause.
It can be caused by an array of hormonal or physical factors. Women with hormonally-caused menstrual irregularities may fail to ovulate and are commonly diagnosed with conditions such as polycystic ovarian syndrome (or PCOS). They may experience physical or emotional stress, significant changes in weight, obesity and glucose intolerance.
Thyroid dysfunction, excess prolactin or androgen and contraceptive use (including birth control pills, rings, intrauterine devices and subdermal implants) can also contribute to changes in the menstrual cycle. At the same time, contraception can often be used to treat abnormal bleeding that is hormonal in nature.
Physical causes of abnormal bleeding include uterine fibroids, adenomyosis (a condition affecting the lining of the uterus), endocervical or endometrial polyps, inflammation of the cervix and cervical or endometrial cancer. Uterine fi broids are very common. They are usually benign and require treatment only when they result in symptoms such as excessive bleeding (rarely with pain), pressure or discomfort.
Polyps are less common, though not unusual, and are easily removed. While for many years, hysterectomy was the only option for treating physical conditions that lead to abnormal uterine bleeding, today a variety of minimally invasive procedures are available.
Regular gynecological exams play an important role in identifying the causes of abnormal bleeding and other menstrual-related concerns.
If you feel your bleeding is having a negative impact on your quality of life, don’t wait. See your Ob/Gyn provider. Many times, a simple adjustment in medications or contraception, an in-office procedure or a short outpatient hospital visit can alleviate symptoms and help you maintain your overall physical and reproductive well-being.
Francisco Rojas, M.D.Obstetrics and Gynecology
Johns Hopkins Community Physicians
6350 Stevens Forest Road, Suite 107
Columbia, MD 21046
PHONE: 443-367-4700
