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From medications and stress to PCOS and STIs, there’s a wide range of reasons Aunt Flo may overstay her welcome
You probably learned in high school that a menstrual period occurs every 21 to 35 days (with most cycles occurring every 28 days). But there’s really no such thing as a “normal” period. Sure, there are general guidelines, but every woman and person assigned female at birth (AFAB) is unique. Some of us have unpredictable cycles, while others experience regular, clockwork menstruation.
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It’s unlikely that something’s wrong if the only issue you’re having is your period being a little longer or other people's. It’s also usually fine for your period to vary a bit from month to month.
But what if you suddenly feel like your period is lasting forever? Is it cause for concern? Ob/Gyn Erin Higgins, MD, offers advice on what might be causing your period to overstay its welcome, how to manage it and when it’s time to see your doctor.
We’ve already mentioned that menstruation isn’t a one-size-fits-all experience. So, before we start listing reasons you might be bleeding more than normal, let’s focus on defining the word “normal.”
A typical period (that is, the time period you’re bleeding) is between two to seven days in length, Dr. Higgins explains. Periods on the longer end of that scale (five to seven days) aren’t something to worry about.
Bleeding for eight days or more, on the other hand, needs investigation, according to Dr. Higgins. In fact, she recommends seeing your provider if you notice any significant changes to your periods, like a difference in frequency, amount of flow, or spotting between cycles.
The list of possible reasons for an extended period is as long as it is personal to you and your individual circumstances. That’s because, Dr. Higgins says, “Long periods can be the result of a variety of factors such as health conditions, your age and your lifestyle.”
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For that reason, Dr. Higgins recommends tracking your period thoroughly, either on paper or digitally. Data, she explains makes everything easier.
“It’s harder to interpret what’s happening when your period’s unusual for a month than it is when you have several months of information about frequency, duration, amount of flow and associated symptoms,” she explains.
Here are a few reasons the crimson wave may bleed into a second week.
It’s not your imagination: Your menstrual cycle really does respond to stress. That’s partially because stress alters your hormone levels, and partially because it also impacts the rest of your body. If you’re experiencing other stress-induced physical issues, your body might not have the energy it needs to react to your cycle the way it normally would. In some cases, the result is a longer period.
Generally speaking, there are two kinds of stress: acute and chronic. If you’re dealing with acute stress — like spending a few weeks preparing for a big presentation — your period may only be irregular once or twice. But if you’re dealing with chronic stress — like caring for an ill family member — irregular periods may start to feel like your new normal.
“When you’re under a lot of stress, it can be hard to squeeze in time to see a gynecologist,” Dr. Higgins concedes, “but it’s also worth it. It’s important to make sure that it IS stress that’s causing issues with your cycle and not an underlying health condition.”
Various forms of birth control can affect the frequency and duration of your period.
“The birth control pill tends to produce a regular period that occurs every month and lasts for three to five days,” Dr. Higgins says. Of course, there are also extended- and continuous-dose versions of hormonal birth control available. If you opt for one of those medications. you only get your period once every three months or not at all.
Hormonal birth control is a great option for regulating your period or preventing pregnancy (among other things … more on that later). But it can take your body time to adjust to it. In fact, your first few months on the medication may be more irregular than usual. It’s also important to keep in mind that “breakthrough bleeding” is a common side effect — especially in the first three to six months on birth control. That unscheduled bleeding may give you the impression that you’re having more (or longer) periods.
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If, after giving it a few months, you’re finding that your cycle has gotten longer, Dr. Higgins recommends speaking to your provider. You may be better off on a different pill — or using a different contraceptive method altogether.
A hormonal IUD usually results in a lighter period (less bleeding) or no period at all. Most people experience spotting for the first few months after getting the IUD. A copper IUD (such as Paragard®) may cause heavier and longer periods for some people.
Progestin-only methods, like the injection medroxyprogesterone acetate (Depo-Provera®) and implantable etonogestrel (Nexplanon®), are associated with irregular spotting as well. But most people report lighter and shorter periods.
When you use an emergency contraceptive like the “morning-after pill,” you’re delaying ovulation. So, irregularities and spotting are to be expected in the weeks following the treatment. If your period doesn’t settle back into its usual rhythm within a couple months, you should let your provider know.
There are many reasons a person might find themselves on a hormone therapy (HT) that have nothing to do with birth control. You may take HT to deal with the symptoms of endometriosis or menopause. Hormone therapy can also be a part of the treatment plan for people with thyroid disorders, while still others are on selective estrogen receptor modulators (SERMs) like tamoxifen that help prevent or treat breast cancer.
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Hormone therapy is also a common feature of gender-affirming care. While many people’s periods slow down or stop altogether (amenorrhea) within one to three months of starting testosterone therapy, others have longer, heavier periods for a few months while their bodies adjust.
“Bleeding and spotting can happen even when you’ve been taking testosterone for a long time,” Dr. Higgins explains. “If you’re bleeding, speak with your provider. There are a few reasons it could be happening and it’s important to rule out an underlying health issue.”
It just makes sense: taking hormonal medications can impact your menstrual cycle. But did you know that other medications can affect the timing, duration and heaviness of your period, too?
Chances are, you have at least one bottle of pills in your medicine cabinet that — in the right circumstances — could lengthen your period. Here are a few prescription and over-the-counter drugs that could be encouraging your period to stick around:
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It’s common to think about pregnancy as a time when you don’t have to worry about bleeding, but that’s not exactly right. Bleeding can — and does — happen during pregnancy and it isn’t always bad news. Still, Dr. Higgins says it’s important to take bleeding seriously if you are (or could be) pregnant.
The following situations can all cause unexpectedly long periods, spotting, or heavy bleeding:
Like pregnancy, Dr. Higgins says breastfeeding (chestfeeding) is a time of big-league hormonal changes. Some people don’t have a period at all while they breastfeed, while others have irregular cycles for a while before getting back into their regular flow (pun very much intended).
If you aren’t breastfeeding at all, your cycle should get back to your personal “normal” quickly.
If you have any questions about postpartum menstrual changes of any kind, it’s a good idea to talk with your provider.
Irregular periods are a hallmark of polycystic ovary syndrome (PCOS). What that means can vary greatly from person to person, but Dr. Higgins says that long, heavy, infrequent or irregular periods are common. It’s one of the many reasons why doctors often prescribe birth control pills for people living with the condition.
Uterine fibroids are tumors — usually benign (noncancerous) — that grow in and on your uterus. While the word “tumor” is a scary one to read, these growths are actually very common. Somewhere between 40% and 80% of people with a uterus will have fibroids at some point in their lives, with most people experiencing them between the ages of 30 and 50.
For many people, their fibroids stay small and don’t cause symptoms. But for some, fibroids mean long, heavy periods and breakthrough bleeding — among other unpleasant side effects. If that is the case for you, rest assured there are many different treatments available.
Uterine polyps — which grow in the lining of your uterus (the endometrium) — are less common and usually appear during menopause or perimenopause. That said, they can also impact the timing, duration and heaviness of your menstrual cycles.
Endometriosis is a fairly common condition where tissue similar to the tissue lining your uterus (the endometrium) starts growing in areas where it doesn’t belong. What that means varies from person to person. For some, it’s a minor concern that causes few (if any) symptoms and — sometimes — resolves on its own. For others, the condition can cause permanent damage and disabling symptoms. As you can probably imagine, most people’s experience lies somewhere between the two.
“Long periods are both a risk factor for endometriosis and a common side effect of the condition,” Dr. Higgins notes. “Another sign you may be dealing with endometriosis is pain that you feel in your lower back, abdomen or pelvic region. If you are having these symptoms, let your gynecologist know.”
Adenomyosis is similar to endometriosis, in that it involves the tissue that lines your uterus growing where it shouldn’t. But the where is different. Adenomyosis is when endometrial tissue grows specifically into the muscle wall of your uterus (the myometrium). That can cause long, heavy — and sometimes painful — periods. That said, about a third of all people with adenomyosis never have symptoms.
Periods can become longer and more irregular as you approach menopause. During perimenopause — the years where your estrogen levels and fertility decline — you can anticipate some pretty intense hormonal swings as your body adjusts to all the hormonal changes.
So yes, irregular periods are to be expected once you enter perimenopause. But just because they’re expected doesn’t mean they should go unexamined.
“It’s important to discuss cycle characteristics with your doctor, especially if you’re over the age of 45,” Dr. Higgins explains. “That’s because the risk of endometrial changes that could go on to cause endometrial cancer increases with age.”
A wide range of infections can impact your period. You can acquire some, like bacterial vaginosis, endometritis and pelvic inflammatory disease (PID), in different ways, not just through intimate contact. There are also several sexually transmitted infections (STIs) that can affect your menstrual cycles. The most common ones include chlamydia, gonorrhea and trichomoniasis (“trich”).
It’s also worth noting that certain infections — like yeast infections — can cause bleeding and spotting that aren’t part of your menstrual cycle.
“If you’re experiencing pain when you have sex or pee, fevers, itching or unusual vaginal discharge, you should definitely get checked out,” Dr. Higgins urges. “If you aren’t comfortable talking about the possibility of having an STI with your regular physician, there are lots of free and anonymous STI testing facilities out there you can take advantage of.”
That butterfly-shaped gland in your neck may be small, but it can have a mighty impact on your periods. That’s because your thyroid makes and releases hormones.
“If there’s reason to suspect your long periods are being caused by thyroid disease of some kind, your provider will probably run some bloodwork,” Dr. Higgins says. “If the bloodwork bears that out, you’ll get referred to an endocrinologist — if you don’t already have one — for specialized care.”
Experts aren’t entirely sure why, but people with chronic kidney disease (CKD) have a higher risk of bleeding of all sorts, including heavy menstrual bleeding (menorrhagia).
There are a number of different blood and platelet disorders that can make it hard to stop bleeding. Some, like hemophilia and von Willebrand Disease, are inherited. Others, like leukemia or a vitamin K deficiency caused by liver disease, are acquired.
We know. Looking up health information of the internet, it can sometimes feel like all roads lead to cancer. They don’t. But gynecologic cancers are common enough that we’d be wrong not to mention it.
“Long periods can be a sign of a precancerous or cancerous lesion of the uterus, but that’s rare,” Dr. Higgins says. “Uterine cancer usually develops during or after the menopause transition.” Cervical cancer, on the other hand, tends to occur a bit earlier — typically between ages 35 and 45. Thankfully, the number of new cases each year is on the decline, thanks to Pap smears and the HPV vaccine.
We mentioned earlier that any change from your normal is worth talking to your doctor about. It’s also worth an appointment if long periods are your normal.
“Many people struggle with long and heavy periods for years without knowing there are ways to manage and improve their symptoms,” Dr. Higgins notes. “I encourage all patients to seek out medical care if they have questions about their menstrual cycle or other gynecologic issues.”
Managing long periods starts with finding out why it’s happening and, if necessary, treating the underlying cause. This can include things like removing an endometrial polyp or managing hypothyroidism with medication.
“Hormonal contraceptives — things like the pill, the patch or a hormonal IUD — are also commonly used to help regulate abnormal cycles,” Dr. Higgins adds. She also urges you to remember that regulating your period rarely happens at lightning speed.
“You should expect it to take three to six months before you’ll notice some improvement,” She advises.
Most causes of prolonged periods don’t qualify as emergencies, but some most definitely do.
If you’re experiencing any of the following symptoms, Dr. Higgins recommends somebody drives you to your nearest emergency room. If nobody can drive you, do not drive yourself. Call 911.
There are lots of reasons your period might keep on keeping on. Most of the time, it’s caused by stress, natural hormone fluctuations or medications. But long periods can also signal an underlying health condition.
Your best bet is letting your provider know about any changes in the timing, duration or heaviness of your period. And if you’re experiencing pain, let them know about that too. Even if the only thing to come from that discussion is some peace of mind, it’ll be well worth it.
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