Is Prolonged Menstrual Bleeding Cause for Concern?

Depending on the circumstances, long menstruation might be a mild condition that can be easily controlled or one that indicates a more serious underlying health issue.

Is It Normal for a Period to Not Stop?

For some women, it may seem as if the bleeding literally doesn’t stop, continuing through the entire month. But this isn’t usually the case.

Since the time between cycles is counted from the first day of your period, a woman who has a 24-day cycle with eight days of bleeding will experience only 16 days period-free. It may seem like you’re always having your period even though you’re within a standard timetable.

What Causes Long Periods?

While irregular menstrual periods can be bothersome, many are caused by hormonal changes, which are common and rarely mean something serious. Younger girls just entering puberty and older women approaching menopause are most likely to experience these hormonally based prolonged or irregular periods.

Usually, a changing level of estrogen is to blame. Estrogen helps build up the uterine lining, called the endometrium, which will support a pregnancy if it is fertilized. If no pregnancy happens that month, the lining is shed as a menstrual period.

Doctors use the term abnormal uterine bleeding (AUB) caused by ovulatory dysfunction when a hormone imbalance is the cause of the bleeding, as noted by guidelines from the American College of Obstetricians and Gynecologists.

In some cases, birth control can impact the frequency, duration, and flow levels of menstrual periods. The copper IUD may cause extra bleeding, Thielen says. And while birth control pills usually shorten your periods, it’s possible some can have the opposite effect. Changing the type of birth control you use may help with this issue. That said, it’s wise to consult your healthcare provider before stopping or altering your birth control strategy so you can understand the potential side effects and risk of pregnancy, as well as devise a plan that’s best for you.

What Underlying Conditions May Cause Long Periods?

A visit with your gynecologist or other healthcare professional is the first step in determining the cause of your prolonged menstrual bleeding. Your doctor will make a diagnosis after performing a series of tests.

Depending on your age and other symptoms, your doctor may test your blood for pregnancy, hormone levels, and thyroid function. Other diagnostic tests may include Pap smears, endometrial biopsies, ultrasounds, laparoscopic surgery, or other procedures.

A wide range of medical conditions can be the cause of abnormal menstrual bleeding. These include:

• Uterine Fibroids These noncancerous growths emerge inside the uterine walls. They can range in size from one tiny speck to several bulky masses. Also called leiomyoma, uterine fibroids can lead to heavy bleeding and periods that last longer than a week.
• Uterine Polyps These small, noncancerous growths appear on (not inside) the wall of the uterus. Polyps are usually round or oval-shaped.
• Endometriosis With this disorder, tissue similar to the type that lines the inside of your uterus abnormally grows outside your uterus, sometimes extensively. In addition to excessive bleeding, endometriosis can cause significant pain.
• Endometrial Hyperplasia This is a condition in which the lining of the uterus, called the endometrium, becomes too thick. An excess level of the hormone estrogen is often to blame.
• Polycystic Ovary Syndrome (PCOS) PCOS is a hormonal disorder that often includes excess levels of the male hormone androgen.
• Thyroid Disease Abnormally high or low levels of your thyroid hormone can cause periods to be long, heavy, light, or irregular.
• Intrauterine Device (IUD) Especially in the first year, a copper IUD can cause heavier menstrual bleeding.
• Pelvic Inflammatory Disease (PID) PID is a bacterial infection in the female reproductive organs. It is most often caused by bacteria acquired during unprotected sex, such as gonorrhea or chlamydia, according to the Mayo Clinic.
• Bleeding Disorders When the blood does not clot properly, it can cause heavy menstrual bleeding.
• Endometrial Cancer Though rare, this cancer of the uterine lining is the most serious cause of prolonged menstrual bleeding.

What Treatments Are Available for Prolonged Menstrual Bleeding?

Many causes of prolonged bleeding can be treated with birth control pills of estrogen and progesterone. This not only provides contraception, but it can also treat bleeding caused by hormones by regulating hormone levels. “Birth control pills generally decrease the overall amount of flow and so should lessen the length of your period,” Thielen says.

In some cases, such as for endometrial hyperplasia, the hormone progestin may be prescribed alone.

Other medicines may also be used. Tranexamic acid (Lysteda) is a prescription drug that treats heavy menstrual bleeding. It comes in a tablet and is taken each month at the start of the menstrual period.

Prolonged bleeding caused by uterine fibroids can be treated with medication or with minimally invasive procedures such as endometrial ablation, uterine artery embolism, or laparoscopic surgery (known as a myomectomy). In severe cases, an abdominal myomectomy or a hysterectomy may be recommended.

Treating endometriosis can be challenging. However, it’s possible to manage abnormal bleeding due to the condition using continuous oral contraceptive pills or the contraceptive injection medroxyprogesterone acetate (Depo-Provera). For painful menstruation due to endometriosis, surgery to remove the unwanted lesions seems to provide the most long-lasting results.

Are There Any Complications From Having a Long Menstrual Period?

Often, the biggest problem with having a long menstrual period is the way it impacts your quality of life. If this is the case, don’t be shy about exploring ways to change your cycle with your doctor.

“It’s okay to treat something simply because it’s a bother. Women don’t have to live that way,” Thielen says

And since blood is rich in iron, women who bleed a lot are at risk of anemia, she says. Talk to your doctor about whether you might need iron supplementation, and what schedule you should take it on. One study found that women taking 120 milligrams (mg) of iron every other day reached the same blood levels after six weeks as women taking 60 mg daily, with the alternate-day dosing causing less nausea.

How Can Birth Control or Menopause Affect the Duration of Your Period?

Birth control pills generally help with prolonged menstrual bleeding, but on occasion may cause it. IUDs, especially copper IUDs, sometimes cause prolonged bleeding, especially in the first year after insertion.

Women in perimenopause, the years leading up to menopause, frequently find their periods changing. Still, even if you’re perimenopausal, you want your doctor to check things out. “Long or irregular bleeding may just be from perimenopause. But it is also often our first clue of endometrial cancer or cervical cancer,” Thielen says.

RELATED: Perimenopause Versus Menopause: What’s the Difference?

When Should You See a Healthcare Professional for a Long Menstrual Period?

If you have a long period for only one menstrual cycle, there’s probably no need to worry. But “if you notice a change for two or three cycles, that’s the time to seek out your doctor,” Thielen says.

Any significant bleeding (as opposed to spotting) between periods without an explanation, such as a recently placed IUD, should be evaluated. And a woman past menopause should have no bleeding at all and so should see her doctor immediately if she does.

Which Healthcare Professionals Can Help?

Several different types of medical professionals can help with prolonged periods. These include:

• Primary care physician
• Gynecologist
• Nurse practitioner
• Physician assistant
• Interventional radiologist