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Menstrual periods - heavy, prolonged, or irregular

Contents of this page:


Abnormal menstrual periods
Abnormal menstrual periods

Alternative Names    Return to top

Irregular menstruation; Heavy, prolonged, or irregular periods; Menorrhagia; Polymenorrhea; Metrorrhagia and other menstrual conditions

Considerations    Return to top

The menstrual cycle is not the same for every woman. On average, menstrual flow occurs every 28 days (with most women having cycles between 24 and 34 days), and lasts about 4 days. However, there is wide variation in timing and duration that is still considered normal, especially if your periods began within the last few years.

If you completely soak through a sanitary pad or tampon every hour for 2-3 consecutive hours, this is considered a very heavy period. A prolonged period is one that lasts longer than 7 days.

A small percentage of women have periods more often than every 21 days or less often than every 35 days. These variations may be normal.

Bleeding may be something to worry about if it occurs between periods, after intercourse, or if you are over age 50, especially if you have already gone through menopause. The risk of cancer increases with age.

Often, if you are bleeding from the rectum or there is blood in your urine, you may think the blood is coming from the vagina. To know for certain, insert a tampon into the vagina to confirm that it's the source of your bleeding.

Causes    Return to top

Home Care    Return to top

Keep a record of your menstrual cycles, including when menstruation begins and ends, how much flow you have (count numbers of pads and tampons used, noting whether they are soaked), and any other symptoms you experience. Tampons should be changed at least twice a day to avoid infection.

Because aspirin may prolong bleeding, it should be avoided. Ibuprofen is usually more effective than aspirin for relieving menstrual cramps.

When to Contact a Medical Professional    Return to top

Call your doctor if:

What to Expect at Your Office Visit    Return to top

Your doctor will perform a physical examination, including a pelvic exam. Your doctor will ask questions like the following to determine the history of this symptom:

Diagnostic tests that may be performed include:

Ibuprofen or another 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.

If a tumor is found, surgery (a hysterectomy) will sometimes be needed. Fibroid tumors (uterine fibroids) are common and are not related to cancer.

Fibroids may stop growing by themselves, and surgery may not be needed depending on the amount of bleeding, the location of the fibroid, and the response to various treatment attempts. Fibroids often stop growing at menopause, so an operation can be avoided by waiting. However, if there has been rapid growth of the fibroid tumor or if your Pap smear is abnormal, surgery or another type of therapy may be 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.

References    Return to top

Osei J, Critchley H. Menorrhagia, mechanisms and targeted therapies. Curr Opin Obstet Gynecol. 2005; 17(4): 411-418.

James AH. More than menorrhagia: a review of the obstetric and gynaecological manifestations of bleeding disorders. Haemophilia. 2005; 11(4): 295-307.

Warner PE, Critchley HO, Lumsden MA, Campbell-Brown M, Douglas A, Murray GD. Menorrhagia I: measured blood loss, clinical features, and outcome in women with heavy periods: a survey with follow-up data. Am J Obstet Gynecol. 2005; 192(6): 2093-2095.

Update Date: 12/12/2008

Updated by: A.D.A.M. Editorial Team: David Zieve, MD, MHA, Greg Juhn, MTPW, David R. Eltz. Previously reviewed by Melanie N. Smith, M.D., Ph.D., Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network (8/17/2007).

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