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Problem Periods: Identifying Causes; Implementing Solutions


By definition, cycles are predictable.

In the case of a woman’s menstrual cycle, bleeding usually occurs approximately every 28 days (although anywhere between 21 and 35 days is normal) and lasts four to seven days. As long as it follows an established pattern that is normal for you, there is no cause for concern.

Abnormal Menstruation

Menstruation is considered abnormal when things are no longer predictable.

While some discomfort during menstruation is considered normal, women who suffer severe cramps are diagnosed with dysmenorrhea.

Women who have not had a period in 90 days or longer (unless they are pregnant, breastfeeding or menopausal) have amenorrhea. The term also applies to young women who haven’t started their periods by age 15 or 16. 

For those who have infrequent periods, the term is oligomenorrhea.

It’s wise to see your doctor if any of these changes occur:

  • Periods that come less than 21 days or more than 35 days after your last one
  • Bleeding for more than seven consecutive days
  • Lighter or heavier than normal flow, or passing blood clots
  • Changing more than 1 pad or tampon every hour
  • Missed periods for more than three consecutive months
  • Bleeding between periods, after intercourse, or after menopause
  • Abnormal or malodorous discharge
  • Pain, high fever, nausea or vomiting during menstruation

Possible Causes

Because the causes of abnormal menstruation are so varied, it’s important to see a board-certified gynecologist to determine what is happening and to rule out serious medical conditions.

Oral Contraceptives:

Because of the hormones, starting or stopping birth control pills will affect a woman’s cycle. Starting oral contraceptives can cause bleeding to become very light or stop altogether, and while some patients’ regularity will return immediately, it can take months for regularity to return when some women stop taking the pill.

Stress/Lifestyle Changes:

It’s no secret that stress can take a toll on our bodies, and it can certainly disrupt your cycle. Sometimes, just a break from routine— such as traveling, illness or dieting— can throw off your normal patterns.   Gaining or losing significant weight can also affect your cycle. Women who exercise a great deal, for example, may also experience amenorrhea.

Premature Ovarian Insufficiency:

Women under 40 can experience symptoms similar to menopause when their ovaries do not function properly. The condition may be caused by a family history, or chromosomal abnormality, or occur in patients who are undergoing chemotherapy or radiation.


When endometrial tissue grows outside of the uterus, it can attach to other organs, including the ovaries, fallopian tubes, intestines or other parts of the digestive tract. The condition can be quite painful, and often leads to abnormal bleeding.

Uterine Polyps and Fibroids:

Whether as small as a seed or as large as a softball, these benign growths do not cause cancer, but they can still cause problems. Some women experience painful periods and heavy bleeding as a result of these growths and may even experience pressure on the bladder or rectum.


Women may contract infections through sexual intercourse, childbirth, miscarriage or abortion. The bacteria can spread to the uterus and other reproductive organs causing widespread pain, abnormal menstruation, vaginal discharge, fever, nausea, diarrhea or vomiting.

Polycystic Ovary Syndrome (PCOS):

Women with PCOS have ovaries that produce too many male hormones, as well as cysts in the ovaries. The condition has been associated with infertility, obesity, type 2 diabetes, excessive hair growth and acne. When hormonal changes disrupt ovulation, it can cause irregular periods or amenorrhea. Treatment options are tailored to the individual and depend on whether or not the patient wishes to become pregnant.

Abnormal cycles can also be caused by certain medical conditions (thyroid dysfunction, pituitary issues, or bleeding disorders), certain types of medications, uterine cancer, or miscarriage.

Diagnosis and Treatment

When you see your doctor for abnormal menstruation, he or she will do an exam, and may order diagnostic tests such as a Pap smear, vaginal cultures, blood tests, pelvic ultrasound or endometrial biopsy.

Treatment, of course, depends on your diagnosis. For example, you might be prescribed hormones to regulate your cycle, pain relievers to help control your discomfort, or discuss the option of surgery if needed.


While there are no foolproof ways to prevent period problems, some lifestyle factors may help minimize your risk.

  • Eat well and do not go on crash diets. If you wish to lose weight, do so in a controlled manner.
  • Exercise moderately, not excessively.
  • Reduce stress and get enough rest.
  • Use all birth control methods consistently and as directed.
  • Change your tampons or sanitary napkins every 4-6 hours to prevent toxic shock syndrome and infections.
  • Get regular checkups.

Seek Expert Advice

As a board-certified expert in both Obstetrics and Gynecology (FACOG) and Female Pelvic Medicine & Reconstructive Surgery (FPMRS), G. Daniel Robison, IV, MD, has a great deal of experience treating the full range of gynecological conditions, including abnormal menstruation. In addition to exceptional expertise, Dr. Robison is well known for his compassionate and respectful approach to women’s health.

If you have questions or concerns about GYN issues of any kind, please contact Advanced GYN Solutions for an appointment: 910.509.0103.