Menstrual and Bleeding Disorders

Every woman’s cycle is different—and it changes over the course of her life. If your period suddenly becomes too heavy, too frequent, too infrequent, or irregular—or stops altogether—there’s almost always a clear cause behind it—and the vast majority of these causes are harmless and easily treatable. On this page, we’ll explain when bleeding is “out of the ordinary,” what might be causing it, and what options are available. We’ll then work with you to find the right solution.

What is a “normal” cycle—and what isn’t?

Today, a cycle is considered normal if it occurs approximately every 24 to 38 days, menstrual bleeding lasts up to 8 days, and the flow remains roughly consistent in both heaviness and regularity (Munro et al. 2024). Bleeding is considered “out of the ordinary” especially if it

• is too heavy—you pass large clots, have to change pads at night or nearly every hour, or feel tired and weak (possible signs of anemia);
• occurs too frequently, too rarely, or irregularly;
• occurs between periods or after sexual intercourse;
• does not occur at all.

Important: It’s not the absolute amount that matters, but whether the bleeding is causing you distress or limiting your daily life. In the first few years after your first period, your cycle needs time to settle into a regular pattern, and shortly before menopause, it often becomes more irregular again—both are normal and usually no cause for concern.

When You Shouldn’t Wait

Please contact us promptly—not just at your next routine appointment—if you experience bleeding after menopause, bleeding after sexual intercourse, very heavy or persistent bleeding, or signs of anemia (fatigue, paleness, shortness of breath during exertion). We’d be happy to evaluate these situations quickly.

What causes it? Two major groups

To identify the cause, we look at two groups (in medical terminology, according to the FIGO “PALM-COEIN” classification):

• Structural changes in the uterus—such as polyps, adenomyosis (more on this → “Endometriosis”), or fibroids (more on this → “Fibroids”). These can usually be easily detected on an ultrasound.
• Functional and hormonal causes—for example, ovulation or hormonal disorders, a blood clotting disorder, or certain medications.

Both types can occur, sometimes even together—which is why we conduct a targeted evaluation before beginning treatment.

If your period stops completely

If your period is absent for an extended period and you are not pregnant, this is a separate issue requiring its own evaluation. There can be a wide variety of underlying causes—ranging from stress, intense physical exertion, or weight changes to hormonal and thyroid disorders, all the way to the onset of menopause. If the condition persists, we’ll take the time to determine the cause; after all, a prolonged estrogen deficiency can weaken the bones over time.

How we investigate

We start with a conversation: What does your cycle look like, what’s causing you stress, and what are your goals—for example, regarding birth control or family planning? This is usually followed by an ultrasound and a blood test; depending on the situation, we check your hormone levels, rule out pregnancy, and, if necessary, take a small tissue sample from the uterine lining. This allows us not only to identify common, harmless causes but also to reliably rule out rarer, more serious ones.

How We Treat You—Together

The appropriate treatment depends heavily on the cause and your preferences—whether you’d like to use contraception, are interested in family planning, or would prefer to avoid surgery. That’s why we develop the treatment plan together with you. Broadly speaking, there are three approaches that we use individually or in combination:

• Non-hormonal: Nonsteroidal anti-inflammatory drugs (NSAIDs, e.g., ibuprofen) and tranexamic acid (Cyklokapron) can significantly reduce the amount of bleeding during menstruation—without any hormones (Lukes et al. 2010).
• Hormonal: The hormonal IUD (LNG-IUD) is particularly effective for heavy menstrual bleeding and also provides contraception (Kaunitz et al. 2010); the “pill,” or combined hormonal contraception (CHC), also regulates the menstrual cycle. If fibroids are the cause, a modern medication (Ryeqo) may also be considered (Al-Hendy et al. 2021).
• Surgical: Polyps and fibroids can usually be removed minimally invasively via hysteroscopy. A hysterectomy is rarely necessary and is considered a last resort when other treatments are ineffective.