If endometriosis has damaged your ovary to the point where you're not ovulating regularly, you may have irregular bleeding. Sometimes you bleed too much because the uterine lining grows too thick before being shed, and sometimes you bleed in the middle of your cycle, usually at times when you least expect it. Adenomyosis (endometriosis that infiltrates the uterine wall) can also cause irregular bleeding.
Few women complain about bleeding too little with their periods — bleeding too much is a far more common complaint! However, bleeding too much may be in the eye of the beholder. Some studies show that approximately 50 percent of the women who thinkthey have heavier than normal periods actually don't.
Bleeding that doesn't fit the norm — either in timing or amount — is called abnormal uterine bleeding (AUB). About 20 percent of women with endometriosis have AUB. The primary cause of AUB in women with endometriosis is anovulation (lack of ovulation), although adenomyosis can also cause AUB. Abnormal bleeding has some unpronounceable names:
I Menorrhagia: Bleeding too heavily every month or for too many days
I Metrorrhagia: Bleeding at odd times
I Polymenorrhea: Periods occurring less than 21 days apart
I Oligomenorrhea: Periods occurring more than 35 days apart
I Menometrorrhagia: Excessive bleeding at irregular intervals
The best way to deal with AUB depends on your age and desire for future fertility (check out Chapter 7 for more on other fertility issues). At one end of the spectrum is benign neglect(do nothing but have your pads and tampons ready). At the complete other end is the ultimate way to stop bleeding, a hysterectomy. However, most of the time your options include medication to regulate your cycles (see "Regulating Your Menstrual Cycle to Reduce the Pain" later in this chapter) or surgical treatments less final than hysterectomy.
Never choose Ignore Itas an option for dealing with AUB. You and your doctor must consider the possibility of cancer in cases of repeated AUB.
Are long cycles harmful?
Although having periods a few times a year doesn't seem like such a bad thing, it can be harmful. Endometriosis growing on your ovary can cause infrequent periods by destroying part of the ovarian tissue. When this happens, your periods come much less frequently than normal. In fact, you may ovulate and have periods only a few times a year. (See Chapter 3 for more on the effects of endometriosis on your ovaries.)
Cycles that occur more than 40 days apart are called oligomenorrhea. Women with oligomenorrhea often have problems getting pregnant and are at risk for very heavy periods. Even worse, over time, oligomenorrhea can increase the risk of overgrowth of the endometrium (called hyperplasia) and, in some cases, endometrial cancer.
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