Abnormal Menstruation: Causes and When to Seek Help - Obstetrics and Gynecology

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Abnormal menstruation can be a concerning issue for many women, especially as they approach middle age. At 45 years old, you are indeed in a phase where changes in menstrual patterns can occur, often signaling the onset of perimenopause. Let's address your questions one by one.

1. What is considered a normal menstrual cycle?
A typical menstrual cycle lasts between 21 to 35 days, with an average duration of about 28 days. Menstrual bleeding usually lasts between 2 to 7 days. However, these numbers can vary significantly from person to person.
2. Is it necessary to seek medical help if the duration is too long?
Yes, if you are experiencing prolonged menstrual bleeding (menorrhagia), which lasts more than 7 days, or if you notice an increase in the volume of blood (such as passing large clots), it is advisable to consult a healthcare provider. Given that your cycles are averaging around 13 days and occurring every two months, this is outside the normal range and warrants further investigation.

3. What could be causing these changes?
Several factors can contribute to abnormal menstruation, especially as women approach menopause. Common causes include:
- Hormonal Imbalances: Fluctuations in estrogen and progesterone levels can lead to irregular cycles and heavier bleeding.

- Uterine Fibroids or Polyps: These benign growths in the uterus can cause heavy bleeding and prolonged periods.

- Endometrial Hyperplasia: This condition involves thickening of the uterine lining, often due to excess estrogen, and can lead to heavy bleeding.

- Thyroid Disorders: Both hypothyroidism and hyperthyroidism can affect menstrual cycles.

- Stress and Lifestyle Factors: High stress levels, significant weight changes, and excessive exercise can also disrupt normal menstrual patterns.

4. Am I approaching menopause?
At 45, you are likely in the perimenopausal stage, which can last several years before menopause officially occurs (defined as 12 consecutive months without a period). During perimenopause, many women experience changes in their menstrual cycle, including irregular periods, heavier or lighter bleeding, and changes in cycle length.
Given your symptoms of heavy bleeding with clots and irregular cycles, it is important to follow up with your healthcare provider. They may recommend further evaluation, which could include:
- Blood Tests: To check hormone levels, thyroid function, and complete blood count to assess for anemia due to heavy bleeding.

- Ultrasound: To visualize the uterus and check for fibroids, polyps, or other abnormalities.

- Endometrial Biopsy: If there are concerns about the uterine lining, this may be performed to rule out hyperplasia or cancer.

In summary, while changes in your menstrual cycle can be a normal part of aging, the symptoms you are experiencing should not be ignored. It is essential to seek medical advice to determine the underlying cause and to discuss potential treatment options. Your health and well-being are paramount, and addressing these changes early can help manage any potential complications.