Abnormal Periods

The Basics
What’s normal—what’s not?
Causes of abnormal bleeding
Treatment options
What to expect at your visit

What’s normal—what’s not?

The average length of a menstrual cycle is usually between 25 and 38 days from the start of one period to the start of the next. Day 1 of your cycle is the day you start your period bleeding, which can last up to a week. We consider any of the following to be abnormal bleeding:
- Extremely heavy bleeding during your period (completely soaking through a maxi pad or super tampon every one to two hours)
- Regularly experiencing bleeding or spotting between periods
- Regularly experiencing bleeding or spotting during or after sex
- Period bleeding that lasts more than seven days
- Menstrual cycles that are very short (less than 24 days), very long (more than 38 days) or that vary in length by more than a week each month.
- Spotting or bleeding during pregnancy
- Bleeding after menopause
Irregular bleeding can happen at any time during a woman’s reproductive life, but is most common during puberty and as a woman nears menopause.
Causes of abnormal bleeding

Sometimes we’re able to figure out what’s causing your abnormal bleeding—but not always. The most common causes include:
- Hormonal changes (such as when you first start having a period or when you stop having periods)
- Fibroids, polyps and cervical lesions
- Medications, including sometimes IUDs or birth control pills
- Adenomyosis (when the endometrium grows into the wall of the uterus)
- Bleeding or clotting disorders
- Miscarriage
- Ectopic (tubal) pregnancy
- Cancer
Treatment options

The good news is that we can often treat your abnormal bleeding, even if we can’t figure out exactly what’s causing it. Treatment options may include prescribing medication (such as birth control pills, progestin pills, hormonal IUD or non-steroidal anti-inflammatory medications) or making adjustments to current medications that may be causing abnormal bleeding. If these conservation options don’t help, we may also consider surgery to address things like polyps, fibroids or cervical lesions.
What to expect at your visit

First, know that not all abnormal bleeding needs to be addressed urgently. If you are having any kind of bleeding during pregnancy or following menopause—or are bleeding so heavily that you’re completely soaking through a maxi pad or super tampon every hour—then our scheduling team will probably have you talk to one of our advice nurses to assess your situation and figure out next steps, which may include an urgent visit. If your abnormal bleeding doesn’t fall into one of these categories, then we’ll probably look for the next available appointment with a provider who has skill and experience addressing your concern.

The provider you see will want to talk about your health history and your menstrual cycle. Keep track of your cycle before your visit, noting when you start your period, how long it lasts and how heavy it is—plus any spotting you have between periods or after sex. Your visit will most likely include a physical exam and your provider may also recommend blood tests, a pregnancy test and/or tests to screen for sexually transmitted diseases. Your provider may also talk to you about having an ultrasound to fully evaluation your uterus and ovaries.