Topic – Abnormal or Heavy Menstrual Bleeding

I’m concerned about how heavy my periods have become. Is this normal, or could I have a more serious problem?

Every woman is unique, and so is her menstrual cycle. For this reason, it is often difficult for a woman to know whether or not she simply bleeds more heavily than other women, or if there’s a more serious health problem she needs to be concerned about. Many women ask their physicians, “How do I know when heavy menstrual bleeding is too heavy?”

Some women experience light bleeding throughout their lives, while others describe their period as very heavy. There is no universal standard by which to measure a woman’s menstrual bleeding as normal or abnormal. However, if your cycle has changed, you require a fresh sanitary pad every couple of hours, or your period lasts for more than a week, you may be suffering from menorrhagia…also known as heavy menstrual bleeding.

Heavy bleeding is related to hormones, especially the hormonal changes that take place during puberty, while using certain contraceptives, or throughout peri-menopause.

Other heavy menstrual bleeding causes include bleeding disorders, blood clotting difficulties, diet restrictions, endometrial polyps, high stress, infection, pregnancy-related conditions, uterine cancer, uterine fibroids, and weight fluctuations.

Heavy menstrual bleeding can seriously affect a woman’s ability to perform her daily routines. But once the underlying cause has been determined, there are various effective treatment options available.

If your menstrual bleeding greatly affects your life, lasts more than a week, seems excessive or different from your norm, or if you have bleeding between periods, after sex, during pregnancy, or after menopause, it’s time to see your physician.

Topic – Abnormal Pap Smears

What does it mean when a Pap smear result is abnormal?

When a patient’s Pap smear (Papanicolaou test) result comes back as abnormal, it’s important to understand what this means…

Routine Pap smears detect changes in cervical cells long before cancer has developed. An excellent way to monitor the presence of cervical cancer, an abnormal Pap smear result alerts women at a very early stage that pre-cancerous cells are present. Remember, cervical cancer can be prevented.

At some point, most sexually active women encounter HPV (human papillomavirus). Not all women who’ve been exposed to HPV develop pre-cancerous changes to the cervix. However, since most cervical cancer is linked to exposure to HPV, it’s vital for every woman to have routine Pap smears.

Sometimes inflammation causes an abnormal Pap smear result; other times, it’s a poor sample and re-testing is all that is needed. When the test indicates cell damage, a colposcopy can be performed in my office. A simple diagnostic procedure that illuminates and magnifies, a colposcopy enables me to microscopically examine your cervix and the tissues of your vagina and vulva.

Based on what I discover, it may be necessary to take a small tissue biopsy and then – depending on these results – more testing may be necessary. Sometimes, all that is required is more frequent Pap smears to monitor the health of your cervix.

Topic – The HPV Vaccine

When is an HPV vaccination advisable?

Certain types of HPV (human papillomavirus) cause cervical cancer, affecting more than 10,000 American women and their families each year…

There are over one hundred and fifty types of HPV, forty of which can infect the cervix. Fifteen types of HPV cause cervical cancer. HPV can also cause anal, penile, oropharyngeal, vaginal, and vulvar cancers, as well as genital warts.

While most HPV infections don’t cause cancer and often go away on their own, infections that persist for years increase the risk of developing cancer.

Because most people don’t develop symptoms, without testing it’s difficult to know whether or not someone is infected with HPV. For this reason, the medical community recommends an HPV vaccination for all girls and women between nine and twenty-six years of age, prior to becoming sexually active.

Topic – Uterine Fibroids

What causes fibroids / an enlarged uterus? Is treatment the best option?

Between forty and seventy percent of American women develop fibroids, which are especially prevalent as women approach their thirties and forties…

Normally non-cancerous, uterine fibroids are tumors that develop from the muscle cells of the uterus, sometimes causing the organ to become enlarged. Fibroids often begin to develop between the ages of thirty and forty, and then continue to grow until menopause.

While the exact cause of fibroids is not known, they tend to run in families. Their growth is connected to hormones as they seldom develop before the first menstrual period, are triggered to grow larger during pregnancy, and tend to shrink after menopause.

Fibroids aren’t life threatening, but they can severely disrupt a woman’s quality of life, and interfere with fertility. Large tumors can cause bladder and bowel issues as well as pelvic pain and abnormal bleeding patterns; heavy bleeding can result in anemia. The biggest complaint about fibroids is the kind of heavy bleeding that can make a woman fearful to leave her home during menstruation.

The size, location, type, number of, and degree of irritation they cause are indicators of what – if anything – ought to be done about fibroids. If fibroids are small and few in number, they don’t usually cause problems or require treatment.

Fibroids – normally detected during a pelvic exam – are usually treated with medications, as a first step. And while the only permanent resolution for fibroids is hysterectomy (the removal of the uterus), this type of surgery is becoming less popular as more minimally invasive approaches have been developed and embraced.


I’m concerned about changes in my menstrual cycle. What, if anything, should I do?

During the peri-menopause years, many women experience bothersome symptoms resulting from hormonal shifts. The time leading up to menopause is difficult for some women – depending on the degree of the effects of hormonal fluctuations – and relatively easy for others.

Women begin peri-menopause at different ages. While signs can begin as early as age thirty, most women become aware of changes in their mid to late forties. Periods may become irregular, and sometimes be more than twenty-eight days apart, and other times less. Bleeding may be lighter or heavier, and may last longer – or not as long as – it used to.

Menopause-like symptoms such as hot flashes, problems sleeping, vaginal dryness, unpredictable breast tenderness, skin changes, and decreased bone density may also be experienced. Most women do not become pregnant as easily as they once might have.

For some women, the duration of peri-menopause can be just a few years, while for others it can last ten or more years. There is no way to predict the length or the severity of peri-menopause and its effects; some women feel much as usual other than a disruption in their cycle, while others experience discomfort and various bothersome symptoms.

Once a woman has gone through twelve consecutive months without menstruating, she has officially reached menopause…which usually occurs between the ages of forty-five and fifty-five. It’s only possible to determine in retrospect which period was the final one, the one that ends peri-menopause.

It’s important to know whether or not changes to your period are linked to peri-menopause or if they’re connected to something else. Various other conditions can cause menstrual bleeding abnormalities such as birth control pills, blood clotting problems, fibroids, hormonal imbalances, polyps, pregnancy, thyroid or structural disorders, or – in very rare cases – cancer.

Once we have confirmed the fact that what you are experiencing is related to this natural life transition, there are treatments available to help ease your symptoms, should you find them bothersome.


I’m concerned about the pain I experience during menstruation. Could I have endometriosis? What should I know about this condition?

Menstrual pain can be a symptom of endometriosis, a condition characterized by the growth of uterine cells in other areas of the body. Endometriosis is associated with irregular bleeding, pain, and difficulty becoming pregnant.

During a woman’s childbearing years, her ovaries produce hormones each month to relay signals to the cells lining the uterus that it’s time to swell and get thicker in preparation for pregnancy. A woman’s body then sheds these extra cells during menstruation.

Sometimes, instead of being shed, these endometrial cells implant themselves outside the uterus and begin to grow in other areas such as the bladder, bowel, fallopian tubes, lining of the pelvic area, ovaries, and rectum. These “implants” begin to behave the same way as the tissue lining the uterus, thickening and then breaking down and bleeding during menstruation.

However, the implant blood cannot flow out of the woman’s body because the implants are outside the uterus. Instead, the implants can become irritated and painful, and sometimes form cysts or scar tissue, making pregnancy difficult.

Depending on a woman’s stage of life and the severity of her case, endometriosis can be managed in various ways. Relaxation techniques, exercise, and medication provide relief for many women.