Q&A With The NP - Abnormal Bleeding

A visit from Aunt Flo, "on the rag", surfing the Crimson Wave - whatever you may call it, most women would prefer to stick to a predictable, manageable, and shorter period. So what's a girl to do when bleeding happens outside of "the time of the month"? This month we sit down with our board-certified women's health nurse practitioner, Erin Mabile, to discuss a common inconvenience: abnormal bleeding. 

My period is very unpredictable, some months it never comes, and other months it is present for weeks. Is something wrong?

There are a handful of reasons why someone may be experiencing an unpredictable cycle. Some include:

• Contraceptive bleeding - missing cycles and having unpredictable bleeding is common with some birth control methods. Examples include hormonal IUDs, the Depo Provera injection, and the contraceptive implant. Low-dose birth control pills may also cause periods to be absent. However, contraceptive bleeding should not include prolonged bleeding or very heavy bleeding. Make an appointment with your provider if you are unsure if the bleeding you’re experiencing is normal. 
• Hormone dysregulation - for individuals not using hormonal contraception, missed cycles and prolonged bleeding are signs that ovulation (the monthly release of an egg from the ovaries) is not occurring. This usually points to an underlying hormonal imbalance and an appointment should be made for further evaluation, including lab work. 
• Pregnancy - a pregnancy test should be taken with any irregular bleeding if there is any chance of pregnancy. 
• Perimenopause - cycles may become irregular and missed periods often occur leading into menopause, which is normal. A good rule-of-thumb regarding when to be evaluated for potentially problematic bleeding is when it is more frequent, prolonged, or heavy. Especially if cycles are more frequent that every 21 days, periods routinely last more than 8 days, if there is bleeding between periods, or heavy bleeding (changing a pad or tampon every 1-2 hours and/or clots that are golf ball sized or larger).   
• Postmenopausal bleeding - bleeding after menopause (defined as going 1 full year without a menstrual cycle), is always considered abnormal and requires an appointment for further evaluation. 

My cycle is very heavy and I have trouble managing my flow, is this normal?

Heavy bleeding requires evaluation. This refers to individuals who frequently bleed through pads or tampons, must wear a tampon and pad together, change a pad or tampon every hour, or pass large blood clots. Uterine fibroids, hormonal dysregulation, clotting disorders, polyps, and uterine cancer are all possible causes of heavy bleeding. 

My period has stopped for the past few months. I am not pregnant or menopausal. Should I be concerned?

As mentioned above, absent menses is a sign of possible hormone dysregulation and should be evaluated. 

Can I still get pregnant if I have irregular periods?

Irregular menses may result in greater difficulty becoming pregnant or maintaining a pregnancy. Individuals with irregular periods who wish to become pregnant should schedule a fertility consult. Those who do not desire pregnancy should not assume they are infertile. Reliable contraception is still strongly recommended.   

What are some conditions that may be causing my abnormal bleeding?

Some conditions are mentioned above, however a more comprehensive list include: 

• Endometriosis
• Polycystic ovary syndrome (PCOS)
• Uterine fibroids
• Uterine polyps
• Early pregnancy
• Sexually transmitted infections (STIs)
• Hormonal birth control and other medications
• Menopause complications

If you are experiencing abnormal bleeding, don't delay being evalutated by a professional. Contact North Atlanta Ob/Gyn today to schedule your appointment with one of our knowledgeable providers.