What is abnormal?
- Cycles shorter than 24 or longer than 38 days
- Variation of more than 7-9 days between cycles
- Bleeding lasting over 8 days
- Heavy bleeding needing hourly pad changes, with clots or affecting daily life
- Bleeding between periods or after sex
- No periods for more than three months (not pregnant)
- Any bleeding after menopause
Causes (PALM-COEIN)
The FIGO classification divides causes into structural and non-structural:
- Structural: polyps, adenomyosis, fibroids, endometrial hyperplasia or malignancy.
- Non-structural: clotting disorders, ovulatory disorders (PCOS, thyroid disease, high prolactin, stress, major weight change), endometrial causes, medication and others.
A study co-authored by Prof. Dr. İkbal Kaygusuz examined VEGF gene variations in unexplained heavy menstrual bleeding.
Assessment
- Pregnancy test
- Blood count for anaemia
- Hormone tests such as thyroid and prolactin
- Transvaginal ultrasound; saline sonography or hysteroscopy if needed
- Endometrial biopsy depending on risk
- Clotting tests when indicated
Treatment
Treatment depends on the cause, age and pregnancy plans. Non-hormonal medicines that reduce bleeding, the combined pill, progestogens and the hormonal IUD are common options. Polyps and cavity fibroids can be removed hysteroscopically. Iron is added for anaemia.
Frequently Asked Questions
When does a late period matter?
Pregnancy should be excluded first in sexually active women. Without pregnancy, no period for over three months needs assessment.
Can stress disrupt periods?
Yes. Severe stress, sudden weight change and excessive exercise can affect ovulation and periods.
Sources
- Munro MG, et al. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes (PALM-COEIN), 2018.
- Investigation of vascular endothelial growth factor (VEGF) polymorphism in patients with idiopathic heavy menstrual bleeding. Archives of Gynecology and Obstetrics, 2022.
The information on this website is for general information only and does not replace a medical consultation.
