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What is it about ?
A normal menstrual cycle varies between 23 and 36 days, most often between 26 and 30 days. The period itself lasts between 2 and 7 days and the volume of normal menstrual bleeding usually varies between 25 and 40 ml, up to a maximum of 80 ml.
Girls have their first period (menarche) on average at the age of 12.5 years. It can happen that everything does not go normally: periods are absent (amenorrhea), the menstrual cycle lasts more than 36 days or less than 23 days, the periods are regular but too heavy, the periods are irregular, bleeding occurs in the middle of the cycle, at the time of ovulation, bleeding occurs at an unusual time or are combined with hormonal therapy or hormonal contraception (breakthrough bleeding).
We distinguish between regular heavy bleeding and irregular bleeding.
Heavy regular bleeding
About 1 in 2 times, the cause is not found, but several mechanisms are thought to play a role. About 1 in 2 times, the cause is in the uterus: polyps, benign tumors, infection, cancer, copper IUD, …
In the remaining cases, the cause lies elsewhere: hemorrhagic disease, thyroid disorders, diabetes, obesity, takinganti coagulants, …
Irregular bleeding
In this case, the cause is often linked to a disruption of one or more hormones (functional bleeding). This disorder often occurs within a few years of having your first period and during the period of premenopause.
Sometimes slight bleeding occurs around ovulation (ovulatory bleeding).
Irregular bleeding can also be caused by polyps, infection, benign tumors, cancer, IUD, hormonal contraception and taking certain medications.
What is their frequency?
Abnormal menstrual bleeding is very common. They are most often harmless, especially in young women. Uterine abnormalities are more common in older women. About 1 in 3 women experience regular heavy bleeding at one time or another.
How to recognize them?
With regular heavy bleeding, the cycle is still normal and regular (the interval between two bleeds is constant), but you lose more than 80 ml of blood with each period. It is not easy to assess this volume of blood with precision. You may suspect abnormal bleeding if you use more sanitary napkins or tampons than usual, if you need to change protection during the night, and if you see clots in your menstrual blood.
In irregular bleeding, the bleeding occurs at an abnormal point in the cycle. Bleeding can also occur after sex.
Light bleeding may also occur during the week before your period (premenstrual discharge) and around ovulation, which is about 14 days before your next scheduled period.
The length of the cycle can also be totally abnormal. For example, there may be no ovulation due to a disorder in the production of hormones, which causes a very short or very long cycle. Cycles that are too short are usually followed by limited bleeding; too long cycles, very heavy bleeding. Possible causes are, for example, stress, excessive exercise, weight loss and polycystic ovary syndrome (PCOS).
Users of the pill or IUD may experience what is called breakthrough bleeding, mainly during the first few months of use. A pill taken irregularly can also be the cause of this bleeding.
How is the diagnosis made?
The doctor will start by asking you questions about your complaints. It may be helpful to keep a journal before consulting it, noting the days of bleeding and how much bleeding. He will ask you if the bleeding is interfering with your normal activities, when you have had these complaints, what contraception you are using, if you are using it correctly, and if there are any bleeding problems in your family.
If the bleeding is irregular, he will take a pregnancy test.
If necessary, he will then perform a vaginal examination to diagnose any abnormalities or infections in the uterus and to do a smear if it has not been done for more than a year.
A blood test can help find other causes, such as a thyroid disorder or an inherited bleeding disorder.
If he is unable to make a diagnosis, he may refer you to the gynecologist for further examinations.
What can you do ?
Periods are often irregular at the start and end of your fertile window. This irregularity is due to hormonal fluctuations. Most of the time, a heavy period is harmless.
Consult the general practitioner in case of very annoying complaints, fatigue, bleeding after sexual intercourse and bleeding occurring more than a year after the permanent stopping of your periods (menopause). It is also best to see a doctor if you have more and more irregular bleeding, is accompanied by fever or pain, or if you are worried about it.
What can your doctor do?
Treatment depends on the cause of the bleeding. Any underlying illnesses must first be taken care of. Tumors, both benign and malignant, are usually removed during an operation.
If the doctor cannot clearly establish the cause of the problem, he will suggest treatment to relieve the symptoms (symptomatic treatment). Iron supplementation may be necessary in case ofanemia. There are several drugs that can reduce bleeding: tranexamic acid (a drug that acts directly on coagulation), an anti-inflammatory, a combined pill or a hormonal IUD.
In severe cases or if the drugs do not produce sufficient effect, curettage may be performed. The procedure involves scraping or removing the lining of the uterus. Removal of the uterus (hysterectomy) is sometimes the only solution.
Want to know more?
- Tranexamic acid – CBIP – Belgian Center for Pharmacotherapeutic Information
- Non-steroidal anti-inflammatory drugs – CBIP – Belgian Center for Pharmacotherapeutic Information
- The combined pill – O’Yes
- The hormonal IUD – O’Yes
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