Why Are My Periods Heavy or Irregular?
The inside of the uterus has two layers. The thin inner layer is called the endometrium. In women who ovulate and menstruate regularly, the endometrium thickens every month in preparation for pregnancy. If the woman does not become pregnant, the endometrial lining is shed during the menstrual period. After menopause, the lining normally stops growing and shedding.
Under normal circumstances, a woman's uterus sheds a limited amount of blood during each menstrual period. Bleeding that occurs erratically or excessive menstrual bleeding is considered to be abnormal uterine bleeding. Once a woman who is not taking hormone therapy enters menopause and the menstrual cycles have ended, any uterine bleeding is considered abnormal.
What Causes Abnormal Uterine Bleeding?
Abnormal uterine bleeding is divided into two categories:
- Hormonal: The normal cycle of ovulation causes a regular monthly period. When ovulation does not occur (known as anovulation), the hormonal cycle is disrupted and unexpected bleeding can occur.
- Anatomic: This includes specific reproductive system abnormalities such as fibroids, polyps, ovarian cysts, and medically induced causes, such as IUDs and estrogen supplements.
What Are the Treatment Options?
Treatment often involves addressing the cause of bleeding or underlying disease and includes hormone and non-hormone therapy or surgical interventions such as:
- Hysteroscopy, Dilation and Curettage ("D&C"): This is a surgical procedure to locate and treat heavy bleeding.
- Endometrial Ablation: This is a hysterectomy alternative that will destroy the uterine lining. It can be performed in the office or in an operating room depending on your preference.
- IUD: This is a small device than can placed in the cavity of the uterus. It contains a hormone called progesterone that helps decrease menstrual flow. It can be placed during an office visit.
- Hysterectomy: This is a procedure to remove the uterus. Most but not all hysterectomies can be performed through a minimally invasive procedure.