Possible Causes of Irregular Menstruation

Q:  I'm 42 years old and have noticed that my periods are heavier than usual. I'm also cramping more than I've done in the past. It's getting to the point where I'd even consider a hysterectomy for the convenience of just not having to worry about it.

I'm not having any flushing episodes and am no more moody than usual. I saw my doctor and had a pelvic exam. He ordered an ultrasound that showed that I have two tumors in my uterus and he is referring me to a gynecologist. I'm more than just a little worried and wonder if you could set my mind at ease.

A:  This is one area of health care that I pay special attention to as I educate my male residents. None of us can identify with the experiences that you are describing, yet it is imperative that we listen sensitively and carefully to what you and other women report to us.

This kind of irregular bleeding has a number of potential causes. One that is often not considered is pregnancy. Couples might discontinue contraception, assuming that conception is a relative impossibility. Although less likely, a pregnancy can occur, with a miscarriage being the source of unusually heavy vaginal bleeding.

Despite the absence of flushing and mood swings, menopause is still a consideration. Any history you can provide regarding the age of your mother or sisters at menopause would be helpful, in addition to a blood test looking for elevated levels of follicle stimulating hormone (FSH) as an early marker.

Malignancy is a possibility as well, with either the uterus or the cervix as a source. A specimen can be obtained from the lining of the uterus through a procedure called an endometrial biopsy that will aid in the diagnosis. Fortunately for most women, cancer of the uterus is very treatable when diagnosed early. Cancer of the cervix is increasingly prevalent due to the epidemic of sexually transmitted disease, especially through a virus known as human papilloma virus. For that reason, women who have multiple sexual partners should get regular Pap smears for early detection.

The ultrasound results you describe are consistent with leiomyomas (fibroids). These are benign, non-cancerous tumors that are often associated with heavy bleeding. Historically, women were encouraged to have hysterectomies with this condition, which is often unnecessary with today's technology and a more enlightened approach to women's health care. A procedure called hysteroscopy may be considered, involving the insertion of a flexible instrument into the uterus and allowing direct visualization of the areas causing the bleeding. These areas may then be managed with hormones or occasionally cauterization of the lining of the uterus, eliminating the need for surgery.

For more information on this topic, see the HealthLink article Many Conditions Can Cause Irregular Periods.

Dr. Russell Robertson is Associate Dean for Faculty Affairs and Associate Professor of Family and Community Medicine at the Medical College of Wisconsin. His biweekly column of medical advice also appears in the CNI Community Newspapers throughout metropolitan Milwaukee.