In this recurring guest column, Kate White, M.D., of Boston Medical Center, answers your questions on all things gynecology. As the author of the Mayo Clinic Press book “Your Sexual Health,” she’s ready to dole out wisdom on sex, periods, menopause and more. Submit a question here.
Q: For the past few months, my periods have been out of control. I used to know exactly when my periods were going to come, and now they feel totally random. Plus, I used to use a few regular tampons a day during my period, and now I’m using at least five “super” tampons. Is this normal? If not, why are my periods getting so crazy?
A: If you’ve had periods for any length of time, you probably have a good idea of how often they come and what kind of (and how many) products to use. Basically, you can generally plan for it. So, when your periods start to get unpredictable or crazy heavy, it can feel like a betrayal of your body (not to mention a serious stressor).
If you’re feeling like your periods are out of whack (a sophisticated medical term), here’s what might be happening.
For newly heavy periods, a few different things may be going on.
You may have uterine polyps, also called endometrial polyps. They’re growths in the uterus usually about the size of your pinky finger or smaller. They can peek out of your cervix or stay tucked inside your uterus. These polyps can cause your periods to get heavy and can cause bleeding between periods.
Or you may have uterine fibroids. These balls of muscle tissue in your uterus start off as small as blueberries but can get as big as softballs or even larger. Fibroids keep your uterus from contracting well during your period, so you end up having heavier bleeding that lasts longer.
Or you may have adenomyosis, a cousin of endometriosis. With endometriosis, tissue similar to the tissue that lines the inside of your uterus — the endometrium — grows outside your uterus, most often on your ovaries, fallopian tubes and along the pelvic walls. With adenomyosis, small deposits of tissue burrow into the walls of the uterus and cause heavy periods.
An ultrasound may be used to detect these conditions.
Now that your periods are irregular, there’s another possibility: Your hormones may be off-balance. When certain hormones in your body aren’t working predictably together, your ovaries might not be signaled to release an egg. Afterward, your uterus doesn’t build up a lining, so you miss a period or have it late. Several conditions could be at play, including issues with your thyroid or pituitary gland. These are often detected with blood tests.
Finally, there’s another big factor to consider if your periods are wacky. You may be getting close to menopause — a time known as perimenopause. This transition into menopause begins roughly four years before your last period. Considering the average age of menopause in the U.S. is 51, this process is likely to start in your mid-40s.
Early on, you may see your periods start to space out or get closer together. (As I type this, my period just arrived 21 days after my last one — and five months ago, I went 60 days in between cycles!) As you get closer to your last period, you’ll likely skip cycles, maybe for months in a row. You know when you’re in menopause when it’s been 12 months in a row since your last period.
The good news? It’s often possible to find the reason for your unusual bleeding — and treatments are available.
Your health care provider may recommend an ultrasound, blood tests or a biopsy of the lining of your uterus to figure out what’s causing changes in your bleeding. If your gyno can find the cause, there will likely be many options for treatment. Even if your testing doesn’t reveal a cause, your health care provider can suggest treatment to help make your life a little easier. And a little less red.
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