Reviewed By Dr. Jacqueline Brooks
Aug. 22, 2001 -- The Monthly Bill. The Woman's Curse. The Stop Sign.
The nicknames we give to the monthly shedding of the uterus lining reflect the troubles it brings, including spotting, heavy bleeding, and cramping. These symptoms can range from merely inconvenient to downright life-changing, depending on how frequent they are and how severe. So how do you know when to grin and bear it and when to see the doctor?
What's Normal and What's Not
"There are only three times in a woman's life when her periods can be irregular but completely normal," says Jonathan Scher, assistant clinical professor of obstetrics and gynecology at Mt. Sinai Medical Center in New York City. Those times are after the first period, or menarche; the first few periods after a miscarriage, abortion, or childbirth; and before menopause. During these times, ovulation is not taking place.
If a woman is of reproductive age, any other change in her usual pattern by a week or more either way is abnormal, says Scher. Heavy bleeding, bleeding between periods -- including light "spotting" -- and missing a period should all be reported to a doctor, he advises.
Heavy or painful menstruation can signal endometriosis, a condition that occurs when endometrial tissue, which lines the uterus, begins to form in other areas in the body, such as on the ovaries or between the vagina and the rectum. This can lead to inflammation within the abdominal cavity, which in turn can cause pain, formation of scar tissue, bowel problems, and infertility.
'Beth' (not her real name) is a 56-year-old Texan whose life was changed when she began bleeding heavily during her monthly cycle. "When I was in my mid-40s, my period became very heavy," says Beth. "It got to the point where I felt I was chained to the bathroom." Her cycle changed, too. "My periods started lasting eight, nine, or 10 days, and the average time in between shortened from 28 days to 25 to 21," she says. "My body was getting more and more run down." When she consulted her doctor, he diagnosed her condition: endometriosis.
A diagnosis of endometriosis is confirmed with a laparoscopy, in which a fiber-optic device is inserted into the abdominal cavity, explains Richard C. Roberson, MD, a family practitioner in Athens, Ga. "In mild cases, nonsteroidal, anti-inflammatory medications, such as ibuprofen, or birth control pills can be effective," says Roberson. "In more severe cases, laparoscopic surgery is often used, as well as hysterectomy -- the removal of the uterus."
Bleeding between periods -- whether heavy or just light "spotting" -- can be a sign of uterine polyps. This was the case for Linda Murray, a 32-year-old San Francisco woman. Polyps are benign growths on the inner lining of the uterus, and may form spontaneously or result from hormone overproduction.
"I started having a period all the time, like spotting but a little more," says Murray. She endured almost constant spotting for six months before consulting her doctor. "I had to wear a panty-liner every day," she remembers.
Murray speaks easily about the situation now that she's undergone minor surgery to remove the polyps. "I didn't know what it was," she says. "I started asking my friends, 'Do you get this?' When I finally went to the doctor, she knew right away what it was. It was a relief."
Fibroids are common benign tumors often found in the uterus. They can form when estrogen stimulates the uterine tissue, and may cause spotting and infertility. Fibroids typically occur in women 30-40 years of age, according to the American College of Obstetrics and Gynecology, and are the most common reason for hysterectomy in the U.S. Many fibroids don't cause symptoms, and they tend to get smaller or go away with pregnancy or menopause.
"If fibroids are not causing pain, excessive bleeding, or other problems, they are best left alone, particularly if the patient is approaching menopause, when the tumors will generally shrink," explains Roberson. Hormone treatments can sometimes shrink fibroids. There are surgical treatments less extensive than hysterectomy that can be used in certain cases, particularly in younger women or those who plan to become pregnant.
When a Hysterectomy Is Needed
It was a hysterectomy that eventually improved Beth's endometriosis. Her doctor gave her two options: a "D and C" (dilation and curettage, where the lining of the uterus is scraped away) or a hysterectomy.
Harris chose the "D and C" first. But when it didn't help much, she consulted with her doctor and decided to go ahead with the hysterectomy. The results? "My lifestyle improved drastically, my physical strength went up, and I felt back to normal."
Not all women recover easily from a hysterectomy, however. A woman should make the decision only after a thorough discussion with her doctor.
Fortunately, most menstrual-bleeding abnormalities are the result of benign conditions, says Roberson, and can be treated without surgery.
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