Abnormal Menses

Typically, menstrual periods last four to seven days. Menstrual problems include periods that occur less than 21 days or more than 35 days apart, missing three or more periods in a row and menstrual flow that is much heavier or lighter than usual.

How is abnormal menstruation (periods) treated?

The treatment of abnormal menstruation depends on the underlying cause:

Regulation of the menstrual cycle: Hormones such as estrogen or progestin might be prescribed to help control heavy bleeding.

• Pain control: Mild to moderate pain or cramps might be lessened by taking an over-the-counter pain reliever, such as ibuprofen or acetaminophen. Aspirin is not recommended because it might cause heavier bleeding. Taking a warm bath or shower or using a heating pad might help to relieve cramps.

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• Uterine fibroids: These can be treated medically and surgically. Initially, most fibroids that cause mild symptoms can be treated with over-the-counter pain relievers. If you experience heavy bleeding, an iron supplement might help prevent or treat anemia. Low-dose birth control pills or progestin injections (Depo-Provera®) may help to control heavy bleeding caused by fibroids. Drugs called gonadotropin-releasing hormone agonists may be used to shrink the size of the fibroids and control heavy bleeding. These drugs reduce the body's estrogen production and stop menstruation for a while. If fibroids do not respond to medication, a variety of surgical options can remove them or lessen their size and symptoms. The type of procedure will depend on the fibroids' size, kind, and location. A myomectomy is the simple removal of a fibroid. A hysterectomy might be necessary in severe cases where the fibroids are large or cause heavy bleeding or pain. During a hysterectomy, the fibroids are removed along with the uterus. Other options include uterine artery embolization, which cuts off the blood supply to the active fibroid tissue.

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• Endometriosis: Although there are no cures for endometriosis, over-the-counter or prescription pain relievers may help to lessen the discomfort. Hormone treatments such as birth control pills may help prevent the overgrowth of uterine tissue and reduce the amount of blood loss during periods. In more severe cases, a gonadotropin-releasing hormone agonist or progestin may temporarily stop menstrual periods. In extreme cases, surgery may be necessary to remove excess endometrial tissue growing in the pelvis or abdomen. A hysterectomy might be required as a last resort if the uterus has been severely damaged.

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