Menstrual periods, abnormal
Alternative names:
periods, menstrual--heavy or prolonged; menorrhagia
Home care:
Bed rest may be recommended if bleeding is heavy.
The number of pads or tampons used should be recorded (so that the doctor can determine the amount of bleeding). Change tampons regularly, at least twice a day.
Because aspirin may prolong bleeding, it should be avoided if possible. For menstrual cramps, use ibuprofen (for example, Advil or Nuprin). Ibuprofen is usually more effective than aspirin for relieving menstrual cramps.
If you use an IUD for birth control, slight spotting is normal. If no other symptoms are present, the spotting is probably insignificant.
Call your health care provider if:
- there is severe pain, or if periods have been heavy and recurrent over 3 or more months.
- there is any bleeding after menopause.
- abnormal bleeding is accompanied by other symptoms.
- there is severe pain, and the pain does not respond to home treatment.
What to expect at your health care provider's office:
The medical history will be obtained and a physical examination performed.
Medical history questions documenting abnormal menstrual periods in detail may include:
- menstrual history
- Are you a woman presently in a menstruating age?
- Was the previous menstrual period a normal amount?
- Do you use tampons?
- Do you normally have regular periods?
- quality
- Is there heavy menstrual bleeding (menorrhagia)?
- Has there been passage of blood clots?
- Is the problem prolonged menstrual bleeding (more than five days per menstrual period)?
- How long per menstrual period is the bleeding?
- How heavy is it?
- time pattern
- When was the last menstrual period?
- What was the age at which you had your first menstrual period?
- How long have you had the same menses pattern?
- aggravating factors
- Do you use birth control pills?
- Do you take an estrogen supplement?
- Do you use an IUD for birth control?
- Do you take aspirin more than once per week?
- Do you take Coumadin, heparin, or other anticoagulant?
- Has there been a recent childbirth, surgery on or near the vagina or uterus, vaginal infection, uterine infection, or other possible source of trauma to the vagina or uterus?
- other
The physical examination may include a pelvic examination if the patient is in the premenstrual phase of the menstrual cycle (particularly if endometriosis is suspected). Uterine blood loss can be estimated if the patient knows how many sanitary napkins or tampons were used during a period.
Diagnostic tests that may be performed include:
Intervention:
Ibuprofen (such as Motrin) or other prostaglandin inhibitor is often prescribed. Ibuprofen is also available in lower dosages (Advil, Nuprin) without prescription.
In some cases of heavy bleeding, dilation and curettage ("D and C") may be required. A hysterectomy may not be performed if having difficult periods is the only complaint.
If a tumor is found, surgery will sometimes be needed; but the common "fibroid" tumor (uterine fibroids) will often stop growing by itself, and surgery may not be needed. Such tumors often grow slowly and stop growing completely at the menopause, so an operation can be avoided by waiting. However, if the pap smear is positive, surgery or other type of therapy is necessary.
If the heavy bleeding is related to hormonal abnormalities, treatment of the specific abnormality will correct the bleeding. Female hormones (birth control pills or progestins) are commonly used to regulate menses.
After seeing your health care provider:
If a diagnosis was made by your health care provider related to abnormal menstrual periods, you may want to note that diagnosis in your personal medical record.
Update Date: 02/09/00
Updated by: J. Gordon Lambert, MD, Associate Medical Director,
Utah Health Informatics and adam.com
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