Women's Health Community

Dear Giftedgrrl: There are two major reasons for very prolonged/heavy periods: hormonal and what I call "structural". "Structural" means when excessive bleeding is due to actual problems within the cavity or walls of the uterus. Some examples of this would include fibroids of the uterus, endometriosis of the muscular wall of the uterus ("adenomyosis"), infections of the lining of the uterus, polyps of the uterine lining, or even uterine cancer. Most of these are present in older women and do not involve irregular periods.

Hormonal causes are usually linked to missed or erratic ovulations. 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. My best GUESS is that this is the cause of your super heavy flows.

There can be MANY causes for not ovulating: thyroid problems, pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors (problems with parents or boyfriends/girlfriends, exams), increased body weight, anorexia, rotating shifts at work, etc.

Hopefully you have also been worked up for other less common causes of too heavy periods in young women such as a blood clotting disorder.

In terms of the severe cramps that can represent an increased amount of prostaglandins (substance that produces contractions of the uterus). Some women will produce more prostaglandins (studies show as much as 13 times as much). A thicker lining of the uterus will also produce more prostaglandins.

PLEASE, please get in to see a GYN--or even your local family planning clinic if money is an issue. They can do a basic work up. Some possible treatments include hormonal forms of birth control to make the lining thinner, or non-hormonal medications such as tranexamic acid (Lysteda).

In Support,
Jane