Most women have menstrual periods that last three to seven days. A woman's period usually occurs every 28 days, but normal menstrual cycles can range from 21 days to 35 days.
 

Examples of menstrual problems include:

• Periods that occur less than 21 days or more than 35 days apart

• Missing three or more periods in a row

• Menstrual flow that is much heavier or lighter than usual

• Periods that last longer than seven days

• Periods that are accompanied by pain, cramping, nausea, or vomiting

• Bleeding or spotting that happens between periods, after menopause, or following sex
 

Examples of abnormal menstruation include the following:
 

Amenorrhea is a condition in which a woman’s periods have stopped completely. The absence of a period for 90 days or more is considered abnormal unless a woman is pregnant, breastfeeding, or going through menopause (which generally occurs for women between ages 45 and 55). Young women who haven't started menstruating by age 15 or 16 or within three years after their breasts begin to develop are also considered to have amenorrhea.

Oligomenorrhea refers to periods that occur infrequently.

Dysmenorrhea refers to painful periods and severe menstrual cramps. Some discomfort during the cycle is normal for most women.

Abnormal uterine bleeding may apply to a variety of menstrual irregularities, including: a heavier menstrual flow; a period that lasts longer than seven days; or bleeding or spotting between periods, after sex, or after menopause.
 

What causes abnormal menstruation?
 

There are many causes of abnormal periods, ranging from stress to more serious underlying medical conditions:
 

Stress and lifestyle factors

Birth control pills

Uterine polyps or fibroids

Endometriosis

Pelvic inflammatory disease

Polycystic ovary syndrome

Premature ovarian insufficiency
 

Other causes of abnormal menstruation include:
 

Uterine cancer or cervical cancer

Medications, such as steroids or anticoagulant drugs (blood thinners)

Medical conditions, such as bleeding disorders, an under- or overactive thyroid gland, or pituitary disorders that affect hormonal balance

Complications associated with pregnancy, including miscarriage or an ectopic pregnancy (the fertilized egg is implanted outside the uterus; for example, within the fallopian tube)
 

How is abnormal menstruation diagnosed?
 

If any aspect of your menstrual cycle has changed, you should keep an accurate record of when your period begins and ends, including the amount of flow and whether you pass large blood clots. Keep track of any other symptoms, such as bleeding between periods and menstrual cramps or pain.
 

Your doctor will ask you about your menstrual cycle and medical history. He or she will perform a physical examination, including a pelvic exam and sometimes a Pap test. The doctor might also order certain tests, including the following:
 

Blood tests to rule out anemia or other medical disorders

Vaginal cultures, to look for infections

A pelvic ultrasound exam to check for uterine fibroids, polyps, or an ovarian cyst

An endometrial biopsy, in which a sample of tissue is removed from the lining of the uterus, to diagnose endometriosis, hormonal imbalance, or cancerous cells. Endometriosis or other conditions may also be diagnosed using a procedure called a laparoscopy, in which the doctor makes a tiny incision in the abdomen and then inserts a thin tube with a light attached to view the uterus and ovaries.
 

When should you seek medical attention for abnormal menstruation?
 

Contact a doctor or medical professional if you have any of the following symptoms:

Severe pain during your period or between periods

Unusually heavy bleeding (soaking through a sanitary pad or tampon every hour for 2 or 3 hours) or passing large clots

An abnormal or foul-smelling vaginal discharge

High fever

A period lasting longer than 7 days

Vaginal bleeding or spotting between periods or after you have gone through menopause

periods that become very irregular after you have had regular menstrual cycles

Nausea or vomiting during your period

Symptoms of toxic shock syndrome, such as a fever over 102 degrees, vomiting, diarrhea, fainting, or dizziness

You should also see a doctor if you think you might be pregnant.
 

How is abnormal menstruation treated?
 

The treatment of abnormal menstruation depends on the underlying cause:

Regulation of the menstrual cycle:

Pain control

Uterine fibroids

Endometriosis: