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angeleyesfromthesouth posted:
I've been having abnormal menstrual cycles for a while, but lately its gotten worse. I just had my normal period two weeks ago and I'm bleeding again. I'm staying really fatigued all the time. I keep headaches and stay weak. I have a doctor's appointment Wednesday but I was wondering if anyone had any advice for me?
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Jane Harrison Hohner, RN, RNP responded:
Dear angeleyesfromthesouth: If you have been having erratic and prolonged bleeding it is good that you will be seeing a GYN. They may decide to to a test for anemia as a cause for the fatigue.

In terms of the abnormal bleeding, there are two major reasons: 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.

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—as missed/late period(s). Alternatively the lining can begin to shed under its own weight producing prolonged bleeding.

There can be MANY causes for not ovulating are multifold: low thyroid, 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. You mentioned headaches. If there is a lesion in the pituitary gland, that can put pressure on the optic nerve and headaches can ensue.

For the next few days you should try and take it easy, stay hydrated, and get your menstrual records in order. If you have kept a calendar with your bleeding dates be sure to take that with you. If you have a family history of any of the conditions mentioned above be sure and share that with the GYN. Hopefully a short course of hormones will get your bleeding pattern back on track.

Yours,
Jane


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