Prolonged Menstrual Bleeding: Is It Normal? - Obstetrics and Gynecology

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Prolonged menstrual bleeding, also known as menorrhagia, can be concerning and warrants careful evaluation. Based on your description, it seems that your menstrual cycle has changed significantly, with a delay of five days and a prolonged duration of bleeding that has persisted for seven days with bright red blood. This is indeed atypical, especially if your previous cycles were more regular and shorter in duration.

Menstrual cycles can vary widely among individuals and can be influenced by numerous factors, including hormonal imbalances, stress, changes in weight, medications, and underlying health conditions. The fact that you have experienced changes in your menstrual pattern over the past four months, including bleeding after your period has ended, suggests that there may be an underlying issue that needs to be addressed.

Common causes of prolonged menstrual bleeding include:
1. Hormonal Imbalances: Conditions such as polycystic ovary syndrome (PCOS) or thyroid disorders can disrupt the normal hormonal regulation of the menstrual cycle, leading to irregular and prolonged bleeding.

2. Uterine Fibroids or Polyps: These benign growths in the uterus can cause heavy bleeding and prolonged periods. They can also lead to discomfort and other symptoms.

3. Endometrial Hyperplasia: This condition involves the thickening of the uterine lining, which can result in heavy or prolonged bleeding. It is often related to hormonal imbalances.

4. Coagulation Disorders: Conditions that affect blood clotting can lead to heavier menstrual bleeding. If you have a family history of bleeding disorders, this could be a consideration.

5. Infections: Pelvic inflammatory disease (PID) or other infections can cause abnormal bleeding patterns.

6. Medications: Certain medications, especially anticoagulants or hormonal contraceptives, can affect menstrual bleeding.

Given the changes you are experiencing, it is important to consult with a healthcare provider, preferably a gynecologist, who can perform a thorough evaluation. This may include a physical examination, blood tests to check hormone levels, and possibly imaging studies like an ultrasound to assess the uterus and ovaries.
In the meantime, it is advisable to keep track of your menstrual cycle, including the duration, flow, and any associated symptoms such as pain or discomfort. This information can be helpful for your healthcare provider in determining the cause of your symptoms.

Treatment options will depend on the underlying cause of your prolonged bleeding. If it is due to hormonal imbalances, hormonal therapy may be recommended. If fibroids or polyps are identified, surgical options may be considered. In cases of endometrial hyperplasia, treatment may involve medication or more invasive procedures.

In summary, while some variation in menstrual cycles is normal, the changes you are experiencing—especially the prolonged bleeding and the pattern of bleeding after your period—should be evaluated by a healthcare professional. Early diagnosis and treatment can help manage your symptoms and address any underlying health issues effectively.