From the Guidelines
If you're experiencing two menstrual periods in a month, each lasting 8 days, you should consult with a healthcare provider for a thorough evaluation to determine the underlying cause of abnormal uterine bleeding. This pattern suggests abnormal uterine bleeding which may be caused by hormonal imbalances, structural issues like fibroids or polyps, endometriosis, thyroid disorders, or other medical conditions. The workup for abnormal uterine bleeding, as recommended by the most recent and highest quality study 1, begins with a thorough history, physical examination, and appropriate laboratory tests, and may include imaging to primarily assess for structural abnormalities. Some key points to consider in the workup include:
- A thorough history to identify potential causes of abnormal uterine bleeding
- A physical examination to assess for signs of underlying conditions
- Laboratory tests, such as blood tests to check hormone levels and thyroid function
- Imaging studies, such as ultrasound, to evaluate for structural abnormalities like polyps, adenomyosis, or leiomyoma
- Endometrial sampling may be considered in patients with abnormal uterine bleeding who have an increased risk for endometrial cancer 1. For immediate management, you can take NSAIDs like ibuprofen (400mg every 4-6 hours) to help reduce bleeding and cramping, as recommended by 1 and 1. It is essential to keep track of your bleeding patterns, including start dates, duration, and heaviness, to share with your doctor, as this information will help guide the evaluation and treatment plan. Prolonged or heavy bleeding can lead to iron deficiency anemia, so your doctor may recommend iron supplements if your hemoglobin levels are low. Treatment options depend on the underlying cause but may include hormonal contraceptives, progesterone therapy, or non-hormonal medications like tranexamic acid.
From the Research
Diagnosis of Polymenorrhea
To diagnose polymenorrhea, which is characterized by two menstrual cycles in one month, with each cycle lasting 8 days, a thorough medical history and physical examination are necessary 2.
Potential Causes and Associations
Polymenorrhea can be associated with various conditions, including changes in estrogen and progesterone hormone levels, which disrupt the normal menstrual cycle pattern 2. Other potential causes and associations include metabolic syndrome, coronary heart disease, type 2 diabetes mellitus, and rheumatoid arthritis 2.
Evaluation and Testing
The evaluation of polymenorrhea may involve routine tests such as:
- Hematocrit or hemoglobin to detect and evaluate anemia 3
- Thyroid stimulating hormone (TSH) level to evaluate thyroid function as a possible cause 3
- Pregnancy test to rule out an incomplete, spontaneous abortion as a cause 3
- Pap test to screen for dysplasia that can suggest a gynecologic cancer cause 3 Additional screening for endocrine disorders that may be causing polymenorrhea include tests of thyroid, liver, and kidney function, and tests of follicle stimulating hormone (FSH), prolactin, and cortisol levels 3.
Treatment Options
Treatment for polymenorrhea can be medical or surgical, and may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 4
- Hormonal therapy with estrogen, progesterone, gonadotropin-releasing hormone agonists, or oral contraceptives 3
- Ovulation suppression (e.g., with oral contraceptives) 4
- Lifestyle changes 4
- Selective serotonin reuptake inhibitors (SSRIs) for associated emotional and behavioral symptoms 4
Key Considerations
It is essential to understand the cause of polymenorrhea to determine appropriate preventive and treatment strategies and to decrease associated health problems 5, 2. A thorough evaluation and diagnosis are crucial to develop an effective treatment plan.