Ask Dr. Young

A normal period may not be different from person to person. To give some general guidelines, your period is NOT normal if you:

• have to change your tampon or pad every couple of hours
• are bleeding for more than seven days at a time
• have to change your pad or tampon during the night
• have a period more frequently than every 2 1/2 weeks (less than 21 days from the beginning of one period to the beginning of the next)

Anytime there is a change in your cycle that persists, you should have an evaluation done by your doctor. A change in your flow may be a sign that something is not normal.¹ Other warning signs include: blood clots, fatigue, or constant pain in your lower abdomen. Having a period is part of being a women but it should not get in the way of your daily activities.²

Take the quiz to find out if you have heavy periods.

You period should not be changing from month to month. This may be a sign that something is not normal and you should visit your gynecologist. Have your doctor provide a thorough examination to find the cause of your irregular period.¹

Make an appointment to see your doctor. I ask my patients to keep a log of how many tampons or pads they use a day and the length of their cycles.

See cycle chart.

Tell your doctor about any medications you are taking.²

First, you need to see your doctor and get an evaluation so that you can find out what is causing your abnormal periods. Then you and your doctor can decide what to do together. There are many treatment options available including endometrial ablation, hormone therapy, and major surgery.

See treatment options.

Hormonal imbalances and fibroids are the cause of 80% of all heavy or long periods.²

• Hormonal imbalances can be treated with hormone therapy, minor procedures, or major surgery. If you are currently on hormone therapy or considering hormone therapy you should be aware that in some cases taking additional hormones can cause heavy bleeding.² Be sure to discuss all of your possible treatments options with your doctor.
• Fibroids are non-cancerous growths, which often produce uncomfortable symptoms such as heavy periods. There are many things you can do to control your symptoms. Talk to your doctor to determine the best approach.^4,1

If you do not have a hormonal imbalance or a fibroid your doctor will probably check for the following: an infection, polyps (a polyp is an abnormal growth of tissue), a bleeding disorder, cysts, dysfunction of the ovaries, endometriosis (endometriosis is the presence and growth of functioning endometrial tissue in places other than the uterus), a pregnancy complication, thyroid problems, lupus (lupus is a chronic inflammatory disease that can affect various parts of the body, especially the skin, joints, blood, and kidneys), liver or kidney disease and in rare cases cancer. Your doctor should do a full set of tests and examinations to be sure of the cause.

If you have an IUD (intra-uterine device) or are on any blood-clotting medications tell your doctor because these can potentially cause heavy or long periods.²

Your doctor should examine your medical history and your menstrual cycle log.

See cycle chart.

I always recommend an ultrasound and a good evaluation of the uterus and other female organs.¹

There are several tests that can help determine the cause of your abnormal periods:

• Hysteroscopy - a light that allows the doctor to see inside the uterus
• Pap smear - may detect an infection, pre-cancerous changes, or cancer
• Blood work - can flag abnormalities
• Dilation and curettage (D and C) - scrapes tissue from the lining of the uterus for evaluation
• Ultrasound - to examine the lining of the uterus and help your doctor determine the shape and size of your uterus

Let your doctor know if you are taking any medications, hormonal drugs, or herbal remedies. It is important for your doctor to rule out any medication that could be contributing to your irregular bleeding.²

In some patients non-hormonal drugs, like ibuprofen, can reduce bleeding. In others it can contribute to their bleeding. If you take any sort of NSAID during your period make a note of how it affects your bleeding. Aspirin is known to prolong bleeding and in many cases should be avoided.⁶ Remember, non-hormonal drugs are for short-term use only. Make sure to tell your doctor about any drugs you are taking.

Tell your doctor what your goals are and discuss what the best treatment option is. Be clear and make sure that your doctor understands your needs. This will allow you to get the best results.

Ask your doctor what procedures he or she has experience with and what results their patients have had with these procedures. The more you know, the easier it will be to decide what is right for you. If your doctor does not have experience in hysterectomy alternatives, consider speaking with another doctor trained in other methods. Once a hysterectomy is done, there is no going back so you want to be confident that you have explored all of your options.

When you have an endometrial ablation only the uterine lining is removed, not the uterus.² This will cause your periods to be a lot lighter or stop altogether. Unlike a hysterectomy, an endometrial ablation is an outpatient procedure that can take as little as 4.5 minutes and recovery should only take a couple of days.⁷

When you have a hysterectomy your uterus is removed, sometimes along with your cervix and ovaries.² Your periods will stop all together, but a hysterectomy is a major surgery and recovery can take up to 8 weeks. Make sure you are certain before you proceed.³

There are always some risks with any procedure. Choose a doctor that has experience performing endometrial ablations and be sure he or she performs a full evaluation to make sure that your uterine structure can support the procedure.¹

See find a physician.

You should only consider an endometrial ablation if you do not plan on having children in the future. Getting pregnant after an endometrial ablation is not impossible but it is not safe.³

You may have some mild cramping, which can be taken care of with naprosyn or ibuprofen.¹ Some patients have heavy cramping in the first 1-2 days which may require stronger medication. Cramping should only last for the first couple of days but it could continue for a few weeks. Also expect to have some bloody or watery discharge for a few weeks.³ An endometrial ablation is an outpatient procedure so you will be able to leave the doctor's office or surgical center when you are finished. Full recovery should only take a couple of days depending on the patient.

I cannot tell you that you will no longer have a period, but 95% of my patients have normal to no bleeding after the procedure. Every patient is different. The best results will come from choosing the best treatment to fit your needs.¹

Hysterectomies are performed too soon and too often. A hysterectomy is major surgery in which the entire uterus is removed and should be used only if other alternatives are not an option.

I recommend talking to other women who have had one. Ask them not only how it affected them physically but emotionally. Some women have reported that they feel a sense of loss or depression. Others have lost their sex drive and/or find it difficult to orgasm.^4,1 You may experience pain from changes that occur in the vagina.¹ If your ovaries are removed you are forced into a menopausal state. Even if your ovaries are not removed a hysterectomy might have an impact on the way they work. Some women experience symptoms such as hot flashes, vaginal dryness, dizziness, and night sweats.⁵ These are all things to be considered. Keep in mind that every woman can have a different reaction.

A hysterectomy has all the same risks as any major surgery. Recovery can take up to 8 weeks and you may feel tired for longer. You need to consider how much recovery time you can afford.⁴

Today there are many other treatment options available that have proven to be very effective without removing female organs.

See treatment options.