Aug. 22, 2001 -- The Monthly Bill. The Woman's Curse. The Stop
The nicknames we give to the monthly shedding of the uterus
lining reflect the troubles it brings, including spotting, heavy bleeding, and
cramping. These symptoms can range from merely inconvenient to downright
life-changing, depending on how frequent they are and how severe. So how do you
know when to grin and bear it and when to see the doctor?
"There are only three times in a woman's life when her
periods can be irregular but completely normal," says Jonathan Scher,
assistant clinical professor of obstetrics and gynecology at Mt. Sinai Medical
Center in New York City. Those times are after the first period, or menarche;
the first few periods after a miscarriage, abortion, or childbirth; and before
menopause. During these times, ovulation is not taking place.
If a woman is of reproductive age, any other change in her
usual pattern by a week or more either way is abnormal, says Scher. Heavy
bleeding, bleeding between periods -- including light "spotting" -- and
missing a period should all be reported to a doctor, he advises.
Heavy or painful menstruation can signal endometriosis, a
condition that occurs when endometrial tissue, which lines the uterus, begins
to form in other areas in the body, such as on the ovaries or between the
vagina and the rectum. This can lead to inflammation within the abdominal
cavity, which in turn can cause pain, formation of scar tissue, bowel problems,
'Beth' (not her real name) is a 56-year-old Texan whose life
was changed when she began bleeding heavily during her monthly cycle. "When
I was in my mid-40s, my period became very heavy," says Beth. "It got
to the point where I felt I was chained to the bathroom." Her cycle
changed, too. "My periods started lasting eight, nine, or 10 days, and the
average time in between shortened from 28 days to 25 to 21," she says.
"My body was getting more and more run down." When she consulted her
doctor, he diagnosed her condition: endometriosis.
A diagnosis of endometriosis is confirmed with a laparoscopy,
in which a fiber-optic device is inserted into the abdominal cavity, explains
Richard C. Roberson, MD, a family practitioner in Athens, Ga. "In mild
cases, nonsteroidal, anti-inflammatory medications, such as ibuprofen, or birth
control pills can be effective," says Roberson. "In more severe cases,
laparoscopic surgery is often used, as well as hysterectomy -- the removal of