Prolonged Menstrual Cycles: Causes and Concerns

Q: Prolonged Menstrual Cycles: Causes and Concerns

Hello： (1) When menstruation occurs, the endometrium sheds in fragments. <br>After the shedding, the spiral arteries in the affected area begin to bleed. <br>At this time, the muscular layer of the small arteries constricts, platelets form a thrombus, coagulation factors are adde

The menstrual period lasted for 10 days before it ended?

My menstrual cycle is approximately 25-27 days, but about two years ago, my period started to last nearly 10 days before it completely ended (previously it lasted about 6-7 days).
The first 3-4 days are normal, but around the 4th or 5th day, I experience a fresh red flow, which then gradually turns brown until it ends.
Before it concludes, I also notice intermittent clear discharge.
Overall, my menstrual period is quite concerning.
I would like to ask the doctor what this issue might be.
I have been married since 2003 and have not become pregnant; could this be related?

yy, 30~39 year old female. Ask Date: 2009/04/30

Dr. Yang Wangjun reply Obstetrics and Gynecology

Hello: (1) When menstruation occurs, the endometrium sheds in fragments.
After the shedding, the spiral arteries in the affected area begin to bleed.
At this time, the muscular layer of the small arteries constricts, platelets form a thrombus, coagulation factors are added to strengthen the thrombus, and the uterine muscle contracts.
These four steps constitute the mechanism of menstrual hemostasis.
(2) If the area of shedding is large and there are many small arteries, the amount of bleeding will be greater, and the uterine cavity may not be able to accommodate it, resulting in a significant amount of bright red blood being expelled through the vagina.
This is typical during the first three to four days of menstruation.
By the end of menstruation, only small areas of the endometrium are shedding.
Due to the reduced amount of bleeding, blood may accumulate in the uterine cavity for a period of time before triggering contractions to expel it.
At this time, the hemoglobin in the blood has been reduced, resulting in brownish discharge.
(3) Based on your description, for your first question, there is still a large area of endometrium shedding on day 5, hence the presence of bright red menstrual blood.
For your second question, the presence of brownish discharge continuing until day 10 may indicate that there is still some small area of endometrium shedding, or it could be that the shedding was completed in the first seven days, but the coagulation mechanism in the area of small shedding is inadequate, leading to intermittent bleeding.
This is similar to what women who have undergone a cesarean section may experience near the incision site.
For your third question, before menstruation ends, there may be intermittent clear fluid, which is the result of a small amount of bleeding where the clot in the uterine cavity has broken down, leaving only clear serum to be expelled.
As for your fourth question regarding difficulty in conceiving, further examination would be necessary to determine if it is related.
(4) There are many reasons that can prolong the shedding time, such as luteal insufficiency or the presence of uterine fibroids.
Additionally, coagulation function should also be evaluated.
Thank you for your message!

Reply Date: 2009/04/30

More Info

Understanding prolonged menstrual cycles and associated symptoms can be complex, as they may arise from various underlying causes. Your description of a menstrual cycle that lasts about 25-27 days, with periods extending to nearly 10 days, along with the presence of bright red blood followed by brown discharge and clear fluid, suggests a few potential issues that warrant further exploration.

Firstly, it's important to recognize that menstrual cycles can vary significantly among individuals and can be influenced by numerous factors, including hormonal fluctuations, stress, lifestyle changes, and underlying medical conditions. The normal menstrual cycle typically ranges from 21 to 35 days, with bleeding lasting between 3 to 7 days. Your cycle length falls within the normal range, but the prolonged duration of bleeding and the nature of the discharge may indicate an underlying issue.

One common cause of prolonged menstrual bleeding is hormonal imbalance. Conditions such as polycystic ovary syndrome (PCOS) can lead to irregular cycles and prolonged bleeding due to anovulation (lack of ovulation). In PCOS, the ovaries may develop numerous small cysts, leading to hormonal disturbances that can affect the menstrual cycle. Other hormonal disorders, such as thyroid dysfunction, can also impact menstrual regularity and flow.

Another potential cause is uterine abnormalities, such as fibroids or polyps. These benign growths can lead to heavier and prolonged menstrual bleeding. Fibroids are non-cancerous tumors that can develop in the uterine wall, while polyps are growths on the inner lining of the uterus. Both can cause symptoms such as heavy bleeding, prolonged periods, and discomfort.

Endometriosis is another condition that can lead to prolonged menstrual bleeding and may cause additional symptoms such as pelvic pain, especially during menstruation. This condition occurs when tissue similar to the lining of the uterus grows outside the uterus, leading to inflammation and pain.

In your case, the fact that you have been married for a significant period without achieving pregnancy could also be relevant. Infertility can sometimes be linked to underlying reproductive health issues, including those mentioned above. It may be beneficial to discuss your menstrual symptoms with a healthcare provider who can conduct a thorough evaluation, including a physical examination, hormonal testing, and possibly imaging studies like an ultrasound to assess for any uterine abnormalities.

Additionally, the presence of clear fluid at the end of your menstrual cycle may be related to normal physiological changes in cervical mucus, which can vary throughout the menstrual cycle. However, if this discharge is accompanied by an unusual odor or discomfort, it may warrant further investigation for potential infections or other concerns.

In summary, while your menstrual cycle length is within the normal range, the prolonged duration of bleeding and associated symptoms suggest that it would be prudent to seek medical advice. A healthcare provider can help determine the underlying cause of your symptoms and recommend appropriate treatment options. This may include hormonal therapies, lifestyle modifications, or surgical interventions if necessary. It's essential to address these concerns not only for menstrual health but also for overall reproductive health and well-being.

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