Aug. 22, 2001 -- The Monthly Bill. The Woman's Curse. The Stop Sign.
The nicknames we give to the monthly shedding of the uterus lining reflect the troubles it brings, including spotting, heavy bleeding, and cramping. These symptoms can range from merely inconvenient to downright life-changing, depending on how frequent they are and how severe. So how do you know when to grin and bear it and when to see the doctor?
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"There are only three times in a woman's life when her periods can be irregular but completely normal," says Jonathan Scher, assistant clinical professor of obstetrics and gynecology at Mt. Sinai Medical Center in New York City. Those times are after the first period, or menarche; the first few periods after a miscarriage, abortion, or childbirth; and before menopause. During these times, ovulation is not taking place.
If a woman is of reproductive age, any other change in her usual pattern by a week or more either way is abnormal, says Scher. Heavy bleeding, bleeding between periods -- including light "spotting" -- and missing a period should all be reported to a doctor, he advises.
Heavy or painful menstruation can signal endometriosis, a condition that occurs when endometrial tissue, which lines the uterus, begins to form in other areas in the body, such as on the ovaries or between the vagina and the rectum. This can lead to inflammation within the abdominal cavity, which in turn can cause pain, formation of scar tissue, bowel problems, and infertility.
'Beth' (not her real name) is a 56-year-old Texan whose life was changed when she began bleeding heavily during her monthly cycle. "When I was in my mid-40s, my period became very heavy," says Beth. "It got to the point where I felt I was chained to the bathroom." Her cycle changed, too. "My periods started lasting eight, nine, or 10 days, and the average time in between shortened from 28 days to 25 to 21," she says. "My body was getting more and more run down." When she consulted her doctor, he diagnosed her condition: endometriosis.
A diagnosis of endometriosis is confirmed with a laparoscopy, in which a fiber-optic device is inserted into the abdominal cavity, explains Richard C. Roberson, MD, a family practitioner in Athens, Ga. "In mild cases, nonsteroidal, anti-inflammatory medications, such as ibuprofen, or birth control pills can be effective," says Roberson. "In more severe cases, laparoscopic surgery is often used, as well as hysterectomy -- the removal of the uterus."