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Forum Name: Gynecology

Question: Period Lasting Longer Than Usual


 SB - Sun Dec 04, 2005 12:18 pm

My period has been coming regular for the pass 9 months this year, however in September i missed that month. I had one in October but it was very light which I found strange because I usually have a heavy flow, during that time I didn't have to wear pads, I wore sheilds. In November, it started light but it progressively got heavier, but it hasn't stopped yet and this has been 7 days. I still get pains in my belly. This has me quite worried it never lasted this long before.
 Dr. Tamer Fouad - Sat Dec 31, 2005 7:32 am

User avatar Hello SB,
I hope you are feeling better now.
Menorrhagia is menstruation at regular cycle intervals but with excessive flow and duration. Clinically, it is defined as total blood loss exceeding 80 mL per cycle or menses lasting longer than 7 days.

If you continued to have heavy bleeding for more than 7 days or any of your cycles exceeded approx. 80 mL of blood loss then you should consult your physician.

For women in their childbearing age the first thing your doctor would want to exclude is pregnancy and pregnancy related complications which include ectopic pregnancy, gestational trophoblastic disease, placental polyp, spontaneous abortion (threatened, incomplete, missed), subinvolution of the placental site.

Next s/he would want to know if you are taking any medicine that is known to cause abnormal uterine bleeding. These include anticoagulation therapy, contraceptive use such as an intrauterine device, Levonorgestrel implant (Norplant System), Medroxyprogesterone contraceptive injection (Depo-Provera), oral contraceptives in addition to hormone replacement therapy and psychotropic agents.

If none of the above causes are found further examination and testing will be directed at exclusion of abnormalities of the reproductive tract such as benign pelvic lesions (adenomyosis, endometriosis, cervical or endometrial polyps, submucosal fibroids) as well as infection, malignancy (if obese/ other risk factors are present) and trauma.
Once all these causes are excluded it can be presumed that you have dysfunctional uterine bleeding. Dysfunctional uterine bleeding is a diagnosis of exclusion. In the vast majority of cases, it is secondary to anovulation (lack of ovulation). The fact that you do not experience cramps or other premenstrual symptoms could be a manifestation of anovulation.

Some common causes of hypothalamic anovulation are weight loss or gain, eating disorders, stress, chronic illness, and excessive exercise. Women with chronic anovulation that is not attributable to any of these causes are considered to have idiopathic chronic anovulation.[1]

Anovulatory bleeding can be thought of as estrogen breakthrough bleeding. This type of bleeding is related to the levels of estrogen stimulating the endometrium. For example, high levels of estrogen for prolonged periods result in amenorrhea followed by acute intermittent heavy bleeding, and continually low levels of estrogen availability result in intermittent spotting.[2]

References:
===========
1. Oreil KA, Schrager S. Abnormal uterine bleeding. Am Fam Physician 1999;60(5):1371-82.
2. Speroff L, Glass RH, Kase NG, eds. Dysfunctional uterine bleeding. In: Clinical gynecologic endocrinology and infertility. 5th ed. Baltimore: Williams & Wilkins, 1994:575-93.

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