“Help! My Period is Controlling my Life!”

Apr 19, 2022

Abnormal uterine bleeding is one of the most common problems affecting women of reproductive age. Normal menstrual periods are typically 21-35 days apart, lasting about five days with moderate flow. When bleeding is outside these parameters, it can cause significant disruptions to a woman’s quality of life. In most cases, the first step in the evaluation of abnormal periods is to try and identify what the source(s) of the problem are. It can be helpful to think about abnormal uterine bleeding as caused by either anatomic/structural problems of the uterus versus problems with hormones, medications, or clotting factors. 

Some causes of heavy or irregular periods can include:

• Fibroids
  • Growths in the uterus that can sometimes cause problems depending on their size and location
• Polyps
  • Typically small growths within the uterine lining
• Irregular or absent ovulation
  • This can occur at any time, but is especially common during the four to five years prior to menopause
• Adenomyosis
  • This occurs when tissue that lines the uterus starts to grow within the uterine muscle
• Medication side effects
• Problems with blood clotting factors
• Problems with other hormones (e.g., thyroid hormones)
• Pre-cancerous tissue in the uterus or, much less likely, a uterine cancer

Testing to evaluate for these conditions typically includes performing a history and physical exam, obtaining lab work and performing a pelvic ultrasound. Sometimes additional testing, such as a hysteroscopy or a saline-infusion sonogram, is recommended. These procedures involve taking a closer look at the uterine lining with a camera or a specialized ultrasound, and are often recommended if an initial ultrasound is suspicious for polyps or fibroids in the uterine lining. 

Once the provider has identified a root cause (or causes) of the abnormal bleeding, he or she can then tailor the treatment recommendations to the patient's individual situation.

Some of the treatment options available for abnormal bleeding are listed below:

• Birth control pills
  • May help regulate periods and make them lighter and less painful.
• Combined hormonal pills specifically for fibroid bleeding
  • Newer forms of hormonal medications are available that balance estrogen and progesterone levels, with the goal of significantly reducing bleeding from uterine fibroids.
• Progestin IUD (intrauterine device)
  • A flexible device inserted into the uterus in the office that thins the uterine lining and helps with bleeding and cramping.
• In-office operative hysteroscopy procedure to remove polyps or fibroids
  • Under sedation, a physician uses a small camera to look inside the uterus and remove any polyps or fibroids seen in the uterine lining.
• NovaSure® endometrial ablation
  • Under sedation, a physician uses a device that opens up within the uterine lining and delivers bipolar energy to the uterine lining to stop it from growing and shedding.
• Vaginal, laparoscopic, or abdominal hysterectomy
  • If more conservative options are not successful, many OB/GYN physicians are all skilled in a variety of hysterectomy procedures, including minimally-invasive approaches. 
  • Hysterectomy involves removal of the uterus. Depending on your age and individual risk factors, your physician may recommend removing your ovaries and/or fallopian tubes as well. If ovaries are removed, hormone replacement therapy with estrogen may be recommended, depending on your individual situation.

In summary, abnormal uterine bleeding is a common problem during the reproductive years. In most cases, identifying the course of the abnormal bleeding can help lead to a variety of treatment options that can significantly improve the quality of life of these patients.

Written by Sarah Pucillo, MD:

Dr. Pucillo joined Women’s Health Care Associates in 2014, when she completed her Obstetrics & Gynecology residency at the University of Colorado. She is a Denver transplant, originally from the north side of Chicago. She has special interests in contraception, high risk pregnancy, minimally invasive surgery, and adolescent gynecology.

Dr. Pucillo lives in the University Park neighborhood of Denver and enjoys many of the outdoor activities that Colorado has to offer. She also enjoys relaxing at home with her husband and two sons, Jack and Sonny. 

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