Last updated: March 3, 2020
Candice Fraser M.D.
Obstetrics & Gynaecology
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Your monthly period may be your least favorite week of the month-but what does it mean if it lasts 30 days?
Periods can be a source of discomfort and stress for women, especially if it seems never ending. If your period lasts longer than five to seven days, you may be freaking out. If your period lasts 30 days or more, it is time to identify the problem! We asked Dr. Candice Fraser to lend her medical insights on what could cause a month long period.
What is a Normal Menstrual Cycle?
Your menstrual cycle is the process in which the female body prepares for a potential pregnancy each month. Your hormone levels rise and fall each month to trigger each step in the menstrual cycle. A normal menstrual cycle can last between 21 and 35 days, although the average is about 28 days.
The Menses Phase: Day one of your menstrual cycle is the first day of your period and the beginning of the menses phase. If you have not become pregnant, the lining of your uterus, which had thickened to prepare for pregnancy, will shed from the uterus through the cervix and vagina.
This phase can last as little as two days or as long as seven. There is no ‘normal’ menstrual cycle. However, it is important to track your menstrual cycle to know what is normal for you and your body.
The Follicular phase: This phase typically occurs between day six and 14, but will vary from person to peroson. During this phase the estrogen levels in your body will rise. This increase in estrogen signals the lining of the uterus, called the endometrium, to thicken to prepare for a possible pregnancy. At the same time a hormone secreted from the pituitary gland in the brain called FSH ( Follicle Stimulating Hormone) will signal the follicles containing the eggs in the ovaries to grow. A fully formed egg, called an ovum, will grow in the second half of this phase. Typically between day 10 and 14.
Ovulation: This phase occurs around the halfway point in the menstrual cycle. In a 28 day menstrual cycle ovulation occurs around day 14. Another hormone called LH (Lluteinizing Hormone), signals the ovaries to release an egg for fertilization.
The Luteal phase: This phase spans the final 14 days of the menstrual cycle.. Once the egg is released, it travels through the fallopian tubes towards the uterus. The remnant of the follicle that released the egg is called a corpus luteum. The corpus luteum secretes the hormoneprogesterone, which makes the lining of the uterus thicker to prepare for implantation of a fertilized egg. If the egg is fertilized, it will implant in the uterus and result in a pregnancy. If it is not fertilized, the estrogen and progesterone levels will fall. This will signal the uterus lining to begin shedding and menses will begin again.
By tracking your cycle, you can learn what is normal for your body and can anticipate your menstrual cycle. A sudden change may indicate a health issue and should not be ignored. If your period lasts more than seven days, you are experiencing heavy menstrual bleeding.
What is Heavy Menstrual Bleeding?
Heavy menstrual bleeding, previously called menorrhagia, is abnormally heavy or prolonged menstrual bleeding. Heavy menstrual bleeding is a common complaint andaccording to the American College of Obstetricians and Gynecologists, one in three women seek treatment for it. Despite its many sufferers, heavy menstrual bleeding can be a sign of a serious medical condition.
You can determine if your periods are unusually heavy if you are soaking a pad or tampon in less than two hours or passing clots larger than the size of a quarter. Your bleeding is considered prolonged if it lasts longer than seven days. It is also considered heavy if you need to change your pad or tampon overnight or need to wear more than one pad at a time to control the flow.
Prolonged, heavy bleeding can impact both your quality of life and your health. Women may find it difficult to live their daily lives normally as they may be constantly visiting the washroom or worried about leakage.Prolonged, heavy bleeding may lead to anemia, which is a blood disorder characterized by not having enough healthy red blood cells. Anemia can be mild without any symptoms or can cause you to feel dizzy or weak, cause breathing problems, heart issues and lead to further health issues.
What Causes Heavy Menstrual Bleeding?
In general, there are three possible causes for heavy or prolonged bleeding during your period.
- Uterine-related problems: Non-cancerous tumors or growths in the uterus can cause heavy or prolonged periods, including uterine fibroids or polyps.
- Cervical or uterine cancer: Heavy menstrual bleeding can be an early sign of cervical or endometrial cancer. This is most commonly diagnosed in older women leading up to menopause or beyond but it is important for women of all ages to speak to theirr health care provider about the symptoms you are experiencing.
- Birth control: An IUD (especially a copper IUD) may causeheavy, prolonged bleeding.
- Pregnancy issues can also cause abnormal bleeding. This can be related to a miscarriage, or ectopic pregnancy. A miscarriage occurs when a fetus (unborn baby) dies in the uterus. An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus. This can be life threatening to the mother and the pregnancy is not viable.
- Hormone-related problems: Heavy menstrual bleeding can be attributed to an imbalance of estrogen, progesterone and other hormones.
- Polycystic Ovarian Syndrome (PCOS) Over 10 percent of women in the U.S. suffer from PCOS. One symptom of PCOS is prolonged periods and heavy bleeding. There is no cure for PCOS, but maintaining a healthy weight, exercising regularly, and eating healthy can help regulate and normalize periods.
- Adenomyosis: This condition occurs when the tissue that normally lines the uterus begins to grow into the uterine muscle. Over time, this can cause an enlarged uterus and heavy or prolonged periods.
- Irregular ovulation: If you do not ovulate regularly the lining of your uterus may become too thick. This is a common condition in women who are in puberty, perimenopause or in women with certain medical conditions, such as polycystic ovary syndrome and hypothyroidism.
- Bleeding disorders—When the blood does not clot properly, it can cause heavy bleeding.
How is Heavy Menstrual Bleeding Evaluated?
If you are experiencing prolonged or heavy periods it is important to prepare for your appointment with your healthcare practitioner. It is helpful to track your periods for a few months to help demonstrate what you are experiencing on a regular basis. Your doctor will be able to see a pattern in what you are experiencing each month, how long your cycle is and how heavy your flow. However, don’t delay seeing a doctor if you are bleeding for several weeks or consistently soaking through a pad or tampon an hour
Your doctor will likely also ask you the following:
- What medications you are on, both over the counter and prescription
- Your pregnancy history
- Past and present surgical procedures and illnesses
- Your birth control method
What Tests are Needed to Treat Heavy or Prolonged Periods?
If you are suffering from heavy or prolonged periods you doctor will likely need to do quite a few tests to determine the cause of your symptoms.
Most healthcare providers will start will a full physical exam, including a pelvic exam. In addition your doctor will likely want to perform the following tests:
- Screening for sexually transmitted diseases
- Pregnancy test
Some additional tests may be necessary based on your age and symptoms.
- Ultrasound exam—This test uses sound waves to make a picture of your pelvic organs.
- Hysteroscopy—Your OBGYN is able to see the inside of your uterus by inserting a thin lighted scope into the uterus through the opening of the cervix.
- Endometrial biopsy—This test examines a sample of the uterine lining under a microscope.
- Sonohysterography—A saline solution is inserted into the uterus through a thin tube and then ultrasound images are made of the uterus.
- Magnetic resonance imaging—This is a imaging test created by using powerful magnets to create images of the internal organs.
How is Heavy Menstrual Bleeding Treated?
Doctors will often try to resolve the symptoms first with medications before trying more invasive procedures.
Birth Control: Birth control is often used to control heavy bleeding associated with polycystic ovarian syndrome, endometriosis, fibroids and problems with ovulation. Depending on the type of birth control prescribed, it may regulate your period, decrease flow or even stop it altogether.
Gonadotropin-releasing hormone (GnRH) agonists: These are used for short periods (less than 6 months) to stop your period and reduce the size of your fibroids. Unfortunately their effect on fibroids is temporary.
Hormone therapy: Hormone therapy is often used for heavy bleeding during perimenopause (the period before you go into menopause.) Tranexamic acid: This prescription tablet is taken at the beginning of the menstrual period to help with heavy menstrual bleeding.
Nonsteroidal antiinflammatory drugs (ibuprofen): can help with both cramps and heavy menstrual flow.
Those with bleeding disorders may be prescribed medication to help blood clot more effectively.
Which procedures can be used to treat heavy menstrual bleeding?
If your doctor determines that medication alone is not enough to stop your bleeding a surgical procedure may be needed:
- Endometrial ablation: This option is often only used after medication and other therapies have been tried. It is because this therapy destroys the lining of the uterus making future pregnancies unlikely. If you do become pregnant after the procedure your risk of serious complications is dramatically increased. This procedure is often accompanied by sterilization or birth control until menopause.
- Uterine artery embolization (UAE): This a procedure where the blood vessels the uterus are blocked. This is used to treat fibroids as it blocks the flow of blood needed for fibroids to grow.
- Myomectomy: This surgery removes fibroids without removing the uterus.
- Hysteroscopy: This surgery can stop the bleeding caused by fibroids or polyps within the uterine cavity by removing them.
- Hysterectomy is the surgical removal of the uterus. It also removes the women’s ability to get pregnant. For this reason it is often only used when other treatment paths have failed. It is also performed to treat endometrial cancer.
When Should I Talk to a Doctor About Long Periods?
Long and prolonged periods may be common, but they are treatable. In many cases, they may be symptoms of a reproductive health issue that needs to be addressed.
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About Candice Fraser M.D.
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