Women's Health Community

Dear angie_lucas:If you are soaking through a superplus tampon or mixing a maxi pad every hour that is bleeding that needs to be evaluated. Even if you go to an ER they will likely still do a pregnancy test as women have become pregnant with a blocked tube--and the result could be a tubal/ectopic pregnancy.

If a pregnancy test is negative than the most common reason for a isolated bleed in a younger woman is a missed ovulation. As you may know, in a normal cycle, estrogen is produced all month. Estrogen is responsible for building up the lining of your uterus so you have something to shed each month.

In a normal cycle, progesterone production increases following ovulation. Progesterone "stabilizes" the uterine lining in preparation for a possible implantation of a new pregnancy. If you are not pregnant that month the levels of estrogen and progesterone fall, triggering the release of the uterine lining—your period. So, if you do not ovulate, the estrogen build up of the lining continues, but without the usual ovulation associated progesterone. Thus, the hormone levels don't decline, and the lining stays up inside the uterus—your missed/late period. Alternatively the lining can begin to shed under its own weight producing prolonged bleeding.

Another way inadequate progesterone production from missed ovulations can create too heavy a flow is as follows. Simply stated, if the uterine lining is like grass or lawn, estrogen is like the fertilizer (causes a thickening of the lining ), and progesterone is like the lawnmower (keeps the lining thin by three different mechanisms). This is why DepoProvera (high dose synthetic progesterone) brings about a thin lining, and why birth control pills (relatively progesterone dominant) bring about shorter, lighter periods. It is also why women who miss ovulations (no progesterone produced) are at a greater risk for too thick lining--and heavier bleeding.

There can be MANY reasons for missing an ovulation: thyroid problems, pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors (problems with boyfriends/girlfriends, money), increased body weight, anorexia, rotating shifts at work, etc.

Bottom line, if your flow continues to be heavy and prolonged you do need to be seen. If you have had a relationship with a GYN (eg for your endometriosis) or even your local county family planning clinic, you try there for an evaluation. It's a lot cheaper than the ER and often you can do a sliding scale fee or payments.

Yours,
Jane