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Menstrual Changes

Why it doesn't always run like clockwork...and when you should see a doctor? Plus: Is it safe to stop your period?

Let's face it: There's nothing fun about getting your period. Still, when it arrives on time, with no unusual symptoms, it can be a source of comfort. A lot of women think of it as an outward sign that all is well on the inside.

But what about a period that is heavy, painful, longer than usual, or spotty? Often, it's nothing to worry about: "A lot of menstrual irregularities are normal," points out Andrew Good, M.D., chief of medical gynecology at the May Clinic in Rochester, Minnesota. Nonetheless, you should check with your doctor to get relief from symptoms as well as to rule out a more serious condition.

Here, five of the most common period problems, how they can be treated, and when you should seek medical attention.

The Great Flood: Unusually heavy bleeding

Possible Causes

Uterine fibroids-non cancerous growths on the uterine wall-are a common culprit. As many as one in four women have fibroids, which can range in size from a pea to a small watermelon. Sometimes, for no clear reason, women in their 30s and early 40s experience extremely heavy monthly flows for up to two years-what are referred to as stormy periods. "Then their bleeding returns to normal without treatment," says Dr. Good. The hormonal shifts of perimenopause-the years leading up to menopause-often bring on heavy periods too.

See Your Doctor

If you need to change your pad or tampon hourly over the course of a day. Bleeding from fibroids can be eased by endometrial ablation (thinning the uterine lining with heat or cold, or with radio waves).

No End In Sight: The long, lingering period

Possible Causes

Typically, a period lasts from three to seven days, but occasionally it can go on. This may occur when an egg is not released, which happens more frequently as a woman nears menopause. According to Dr. Good, "When you don't ovulate, your body doesn't produce enough progesterone, which signals your period to stop." Other causes include an infection or an under active thyroid.

See Your Doctor

If you bleed longer than a week for three consecutive menstrual cycles.

Too Close For Comfort: Frequent periods

Possible Causes

A Sluggish thyroid can also shorten your cycle; so can an overactive thyroid. (Typically, a menstrual cycle ranges from 23 to 35 days, though even a 21-day cycle can be normal.) If you're over age 45, blame perimenopause. As you get older, your body produces more follicle-stimulating hormone, which prods the eggs to develop faster. This, in turn, can make you ovulate earlier than you normally would, shortening your menstrual cycle.

See Your Doctor

If your cycle is shorter than 21 days.

On Again, Off Again: Irregular periods

Possible Causes

Stress, extreme weight loss, intense exercise, and even sleep deprivation can throw hormones out of whack. This keeps the uterine lining from thickening and then sloughing off, triggering your period. "When you're under stress, emotional or physical, you may ovulate less frequently." "It's nature's way of helping you to avoid a badly timed pregnancy."

Once again, perimenopause could be to blame. In younger women, the cause may be Polycystic Ovarian Syndrome (PCOS), a metabolic imbalance that raises testosterone levels and affects the body's ability to use insulin properly.

See Your Doctor

If you miss three periods in a row or if your periods are often far apart or irregular. Learning how to handle stress may eventually get you back on a regular cycle.

Bleeding In Between Times: Spotting

Possible Causes

Spotting that consistently happens two weeks prior to your period is often the result of estrogen levels dipping just before ovulation. Generally, it's nothing to worry about. But polyps, fibroids, an ectopic pregnancy, or even uterine cancer can trigger spotting.

See Your Doctor

If your spotting can't be linked to ovulation.

Painful Period Rx

Cramps typically start when prostaglandins-hormones that cause the uterus to contract, accumulate. The best way to head off pain is to prevent the buildup by taking anti-inflammatories such as Boswellia, two to three days before your period begins. And during the time you cramp.

Want To Have Fewer Periods

Seasonale-conventional oral contraceptives repackaged in a purple-and-pink plastic box has pushed into public view a lesser-known way of stopping periods known in medicine as menstrual suppression. The promise: No muss or fuss and fewer cramps, migraines, chocolate cravings and mood swings.

But drugs, like almost everything else in medicine, come with drawbacks and unknown risks. "This is homogenizing women, chemicalizing them into uniformity," says Dr. Susan Rako, a Boston Doctor, Harvard University-trained and author of "No More Periods: The Risks of Menstrual Suppression and Other Cutting-Edge Issues About Hormones and Women's Health" (Harmony Books; $21)

The known methods of menstrual suppression put women at increased risk of osteoporosis, infertility, heart attacks, strokes and cancer. Menstruation actually lowers blood pressure levels by half each month, decreasing a woman's risk of heart-related problems.

She calls menstrual suppression "irresponsible and hazardous" and cites 225 scientific references in her book to bolster her argument.

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