by Thomas Vaughan,M.D.

        Many women have a problem that occurs monthly and is disruptive to their normal daily activities.  I am referring to heavy and prolonged menstrual cycles or persistent recurrent irregular bleeding.  A normal menstrual cycle usually occurs every 21-35 days, images[4]lasts from 4-7 days and is not excessively heavy.  Heavy or prolonged menstrual cycles are the most common form of abnormal uterine bleeding.  Bleeding may be considered abnormal if bleeding is heavy enough to soak a pad or tampon every hour for several hours, lasts longer than seven days, is associated with passing large blood clots or causes nighttime bleeding that requires getting up to change pads or tampons.  Bleeding that occurs to this degree should be evaluated because it may be indicating an underlying condition that should be treated.

        Abnormal uterine bleeding may be caused by many different conditions—the acronym : PALM-COEIN is currently used to indicate the different causes that may be result in heavy bleeding:

        P-Polyp/ (Pregnancy complications should be considered as well)

        A-Adenomyosis (problem with endometrial tissue)

        L-Leiomyoma (fibroids)

        M-Malignancy & hyperplasia

        C-Coagulopathy (clotting impairment)

        O-Ovulatory dysfunction



        N-Not yet classified

The different conditions that may cause abnormal uterine bleeding may also be related to your stage of life: Premenarche, reproductive age, and postmenopausal.

         If you are having abnormal bleeding it should be evaluated so appropriate treatment may be used.  Evaluation usually startsk11235970[2] with a medical history and physical exam, which may then indicate the need for laboratory testing, pelvic imaging studies and possibly an endometrial biopsy.  After the initial evaluation to determine the likely cause, treatment options may be considered:

        Medical –

              Non-steroidal anti-inflammatory agents: e.g. ibuprofen or naproxen

              Hormonal therapy to stabilize the endometrium: e.g. oral

                     contraceptives or cyclic progestins

              Hormone secreting IUD: Mirena or Liletta

              Lysteda (tranexamic acid), a non-hormonal medication that promotes

                       blood clotting

        Surgical –

              Diagnostic/Therapeutic hysteroscopy with dilation and curettage

              Endometrial ablation


        If you are having problem bleeding, please consult with your medical provider —untreated , heavy bleeding can lead to anemia , fatigue, embarrassing accidents and prevent you from being as active as you would like to be.