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ask: long periods? 3 weeks

By Anonymous
 
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I've been experiencing long periods for a while now. I am 51. They last about 3 weeks, taper off like a normal period and then bamm...my new period comes! My periods are like clock work, very regular approx. 28 days or whatever the cycle is suppose to be. So, I've had it for 3 weeks, then the other period comes back to back for sometimes another 3 weeks! My doctor had me go on Aygestin..first take 3 per day for 10 days, 2 per day for 10 days and then 1 per day for 10 days. I did not feel comfortable taking so many, but I did it. My period then stopped for about a week. Then it came on again like clock work, went on for about 3 weeks and now again going on for a week! I started to take the Aygestin again, but this time only taking 2 pills a day for 10 days, then will cut down to 1 pill for 10 days. My doctor suggested a hysterectomy if needed, but no way do i want to do that! I do have fibroid tumors as well. I am taking iron. My homone blood test came out normal. Should I try taking a saliva test? What advice can you give to me...my bleeding is like a normal period, no blood clots...just heavy in the beginning then tapers off.
Thank you

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EmpowHER Guest
Anonymous

I am 42 and have been having the same experience as Anon for 4.5 years in that my periods last 3 weeks - they start off normally and after about 2 days I get black dryish clotting that goes on for the 3 weeks. Then I get the start of a new period. I have had scans, internal examinations, pap smears twice or 3 times a year over period of 3 year and have been told that there is nothing wrong. The contraceptive injection does not work and neither does the pill in terms of regulating this. I have been told by a consultant specialist at my local well woman clinic that some women just bleed and that while this is fairly uncommon it does happen. The only solution I have been offered is a total hysterectomy. I don't want to have major surgery that will leave me scarred for something that is going to sort itself out naturally via the menopause. I may have to wait another 10 years though. It has made my life miserable and I wish someone could help me.

February 26, 2012 - 5:07am
Dr. Philip M. Sarrel Expert

Hello anon, These are my best thoughts on your situation as one of the gynecologists who is available to help women contacting EmpowHer. I've reviewed the information you sent and the responses of the EmpowHer guides. You are right that the cause of your bleeding needs to be diagnosed before the discussion about treatments.

You and your doctor already know a great deal that's helpful: you have fibroids; you have cycles in which your own progesterone is being produced; you have a past study showing an ovarian cyst; you had a course of treatment with Aygestin and after that went right back to your bleeding pattern. You don't need any more hormonal studies.

Where do you go from here ? Back to your doctor. She can easily do a "transvaginal ultrasound" which will evaluate the lining of your uterus and the potential for the fibroids to be the main cause of the bleeding. The ultrasound might also show a "polyp"-more about that later.

She may (probably?) suggest you have a "D&C". A "D&C" is a surgical procedure involving a scraping of the tissue inside the uterus. Although a D & C is a diagnostic procedure it can also cure the problem. Local anesthesia can be used for the D & C so that you don't have to worry about your anxiety about being put to sleep. A D & C takes about ten minutes. Your doctor might also want to do a "hysteroscopy". That is a procedure in which a special kind of microscope is used to look inside the uterus
and examine what's in there that might be causing your bleeding. The hysteroscopy can be done at the time of the D & C.

Although the bleeding you're experiencing is extremely common, it shouldn't be ignored and a definite diagnosis should be made. No one has mentioned a "polyp"-a kind of overgrowth of a blood vessel in the lining of the uterus, but that could also be causing your problem and could be easily removed at the time of a D & C.

Cancer in the lining of the uterus would be quite rare in a woman with your history. I mention it because prolonged bleeding can be a sign of uterine cancer. That makes it all the more important to get the problem diagnosed and resolved.

I hope this is helpful.

August 28, 2009 - 4:12pm
Alison Beaver

Diane gave you some great information, and I wanted to add some information to your list of credible online resources while we wait for one of our medical experts. (In case you are curious about my background & training, I have a BA and MA in Health Education--basically my job is to sift through the medical literature and other health and wellness sources, to provide you with the most recent, credible and evidence-based health information available).

According to the American College of Obstetricians and Gynecologists (ACOG), (most likely the site your doctor uses), there are many options for the treatment of fibroids, and as Diane said, it depends on many factors (size and location of fibroids, for example). Your treatment options may include medication and surgery:
1. Progestin, as it reduces heavy and painful bleeding but does not treat the fibroids themselves.
2. Birth control pills and other types of hormonal birth control methods. These drugs often are used to control heavy bleeding and painful periods.
3. Gonadotropin–releasing hormone (GnRH) agonists. These drugs stop the menstrual cycle and can shrink fibroids.
4. There are many other options for fibroid treatment through surgery, other than a hysterectomy ("a Myomectomy is the surgical removal of fibroids while leaving the uterus in place"). You can read more about surgery options at the ACOG site, but it does not sound like this is a viable option for you at this point.
5. Myolysis (meye-OL-uh-siss) - A needle is inserted into the fibroids, usually guided by laparoscopy, and electric current or freezing is used to destroy the fibroids.
6. According to, Women's Health.Gov, some treatments that are still being developed include:
a. "MRI-guided ultrasound surgery shrinks fibroids using a high-intensity ultrasound beam. The MRI scanner helps the doctor locate the fibroid, and the ultrasound sends out very hot sound waves to destroy the fibroid. The ExAblate® 2000 System is a medical device that uses this method to destroy uterine fibroids."
b. "Some health care providers use lasers to remove a fibroid or to cut off the blood supply to the fibroid, making it shrink."

I have not been able to locate any clinical studies proving the efficacy of any complementary or alternative medicine techniques as effective treatments for fibroids.

I'm curious, though, in your original and subsequent posts. Your primary concern was long periods, and then you mention that your periods are regular (I guess you mean the week in between that you are not bleeding?).

It sounds like your fibroids may be causing your abnormal periods and bleeding (or, it could be perimenopause, as Diane mentioned), as a normal period is defined as:
* Occurs every 21 to 35 days
* Lasts four to five days
* Produces a total blood loss of about 2 to 3 tablespoons

The medical term for what you are experiencing is "menorrhagia" (can mean excessive bleeding or prolonged bleeding), and may include any or all of these:
* Produces a total blood loss of about 5 1/2 tablespoons or more
* Interferes with your life
* Causes tiredness, fatigue or shortness of breath (symptoms of anemia)
* Menstrual periods lasting longer than seven days
[Source: Mayo Clinic]

Is your doctor concerned about the size or location of the fibroids? Is your lengthy periods causing discomfort or otherwise negatively effecting your life? What are the main symptoms you want treated, as you have not mentioned any pain or other problems.

If you are nearing menopause, your other option may be to wait (your doctor will know if this is an appropriate option for you), as your fibroids may not require treatment (this thought assumes that your fibroids are "caused" by estrogen, however, the actual cause of fibroids is still unclear), as the medical literature suggests that fibroids shrink as women enter menopause, most likely from the decrease in estrogen.

Does this help?

August 27, 2009 - 1:35pm
EmpowHER Guest
Anonymous

I sure will be waiting, thanks so much! I am also pulling up your recommended reading that you sent to me. It could be the fibroids, since I do have about 6 of them and 2 are about the size of a golf ball. But, now that I found from a year ago, the item about a cyst on my ovary measuring 3.3, that concerns me? So, basically you are saying that if someone is in Perimenopause it is normal to have lengthy periods....but not normal to have it as long as I do, correct? I guess it could be the fibroids! I really do not want to have surgery due to my paranoia about being put under.
Thank you

August 27, 2009 - 9:14am
Diane Porter

Hi, Anon!
No, I'm not a doctor and I don't have medical training at all. I am a journalist who knows how to research things and find answers; and at EmpowHer, we have a lot of resources available to us to help us do that. We also have a panel of experts who ARE medical doctors in many fields that we can submit questions to if they are more specific or more technical than we can answer with research.

I am really glad you have all your specific test results, and I would like to submit your question to one of our experts. I'll do that today. It will take us a few days to get an answer back, so hang in there with me, OK?

August 27, 2009 - 9:07am
EmpowHER Guest
Anonymous

Hi, thanks so much for responding back so quickly since I am new to this site, may I ask who are you? Are you a doctor or someone who has gone through many symptoms in the past to share your experiences. Curious! :) My doctor suggested to go on iron, over the counter iron to make sure i do not get anemic. My blood levels are supposively fine, I am not anemic. She mentioined also that I might want to consider doing a procedure that removes my fibroids? I forgot what it is called. But, yes I have about 6 fibroids, one is about a golf ball size, she is not sure if that is the cause of my periods. The periods I get, yes is 3 weeks long, but not continued to be heavy...it is like a normal period that tapers off. I do not feel comfortable taking the Progestin. I do not like to be put to sleep,have a slight paranoia over that. I found my hormone tests: Progesterone - 11.0, Estradiol: 92, I had a CBC panel done don't think you want all those numbers, but they show in range and had FSH: 7.2.
Here is my question...why wouldn't it be just perimenopausal and nothing else because my periods are regular and just seem to take its time to slack off? How can fibroids do that if my periods are of normal timeframe..clockwork. Also, I did find just now some medical record donw a whle ago on me back July 2008, I had a CT scan done because I had pain on my right side, everything looked fine except a cyst was found on my ovary measuring 3.3x3.0x3.5cm on right ovary, then a smaller one on left ovary of 1.5x1.5x1.8. can that cause longer than normal bleeding?
Should I stop taking the progesterone? Does not seem to help anyways? Is there any natural things I can do? You asked that sounds like I have a good responsive doctor do I feel that way? Not sure, I do not like the fact that she was so quick to suggest a hysterectomy when she was still uncertain of the cause of the problem. My stomach does seem to be full, no painful periods, just normal PMS, no frequent urination, some heavy bleeding just near the beginning stages of period, no lower back pain. Whatever suggestions you can give would appreciate. Thank you...

August 27, 2009 - 8:57am
Diane Porter

Hi, Anon, and welcome to EmpowHer! Thank you so much for your question.

Clearly, you are in perimenopause. Even though your cycles come at regular intervals, periods that last 3 weeks long are not normal. Sounds like you have a good doctor who is being responsive to you; do you feel that this is the case?

Have you been discovered to be anemic, with the constant blood loss? Is that why you're taking iron?

When you had your hormones tested, do you know which hormones were measured? (And by the way, the fact that they came out "normal" doesn't mean that there might not be a hormonal issue. Your personal normal might be different. I wish we all had our hormones tested at a baseline level in our 20s or 30s so that we'd know, later in life, what "normal" was for each individual person.)

Many doctors believe that the saliva test is more accurate for actually gauging proper hormonal levels, but there is some disagreement on that -- others swear by the blood tests. Hormone levels can change, though -- throughout the month even -- and so it's a good idea to have them retested anyway.

Aygestin is a progestin tablet. Because of the fact that your doctor prescribed it and the schedule on which you are taking it, I am wondering if she/he believes you are estrogen-dominant? Was that term ever mentioned?

Here's the explanation of when Aygestin is used from Rxlist.com:

Aygestin is indicated for the treatment of secondary amenorrhea, endometriosis, and abnormal uterine bleeding due to hormonal imbalance in the absence of organic pathology, such as submucous fibroids or uterine cancer.

Amenorrhea is actually the absence of a period, which you obviously don't have!
Have you ever had endometriosis? Do you have bad cramping with your periods?

Do you know how large your fibroids are?

Here are the dosing guidelines with Aygestin; they sound like what your doctor is doing:

http://www.rxlist.com/aygestin-drug.htm

You are certainly not alone. Here are two pages where women are dealing with the same problem:

http://www.menopauseinsight.com/blogs/menopause_questions__answers/archi...
http://yourtotalhealth.ivillage.com/irregular-heavy-long-periods.html

If your hormone levels were indeed normal -- and if a second test shows them to be so -- I would think that the attention would be centered on your fibroids. Is that why your doctor has suggested that a hysterectomy might be beneficial? Were any other responses to the fibroids considered?

Here is the Mayo Clinic's page on treatment of fibroids:

http://www.mayoclinic.com/health/uterine-fibroids/DS00078/DSECTION=treat...

Here are some of the other symptoms of fibroids; are you experiencing these as well?

heavy bleeding (which can be heavy enough to cause anemia) or painful periods
feeling of fullness in the pelvic area (lower stomach area)
enlargement of the lower abdomen
frequent urination
pain during sex
lower back pain

I realize I'm asking as many questions as you are, LOL, but I want to try to help hone in on what could actually be going on here and get you the best information possible. See if you can answer my questions, and let me know what, if any, of this information sounds most pertinent to you and we'll see what more we can find, OK?

August 27, 2009 - 7:53am
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