I'm a 48-year-old woman who suffers from irregular menstrual periods with extreme bleeding and huge clots. Every few months I have one that lasts three to four weeks. My gynecologist says I'm just a heavy bleeder. My GP sent me for an ultrasound, and there were no abnormalities. What could cause such a situation? Are there things I can do, or avoid doing, to reduce the severity of this every month? I have spoken to many women who suffer like I do. It's difficult to function outside of our homes and at work. There is minimal cramping so it's not painful, but it's terrifying never knowing when we'll stand up and have a gush that soaks our beds, etc. Needless to say I am anemic, with a ferritin of less than 5. What I can ask my doctor to do? I'm tired of just accepting this.

L.

Bleeding for three to four weeks at a time, to the point of becoming anemic, is not normal. You may be a "heavy bleeder," but why? The cause should be sought out. Some women have a problem with the blood's ability to clot properly; diseases such as Von Willibrand's can produce heavy periods, as well as nosebleeds and easy bruising. Between 12 and 20 percent of women with abnormally heavy periods have this disease, which interferes with the platelets' ability to cause a clot to form. Treatment is available, and a fairly simple series of blood tests (PT, PTT, bleeding time, ristocetin cofactor, factor VIII and Von Willibrand factor levels) can be done to make the diagnosis.

Other possible causes for such heavy bleeding include a fibroid (a benign growth of the uterine muscle), especially if it is located just beneath the uterine lining, projecting into the uterine cavity. Polyps of the uterine lining also may be associated with heavy bleeding; a routine ultrasound may miss polyps, which are better diagnosed by a saline infusion ultrasound (which involves instilling fluid into the uterine cavity while doing an ultrasound) or hysteroscopy. Adenomyosis, in which the uterine lining tissue penetrates into the wall of the uterus, is frequently associated with heavy bleeding. Hormone imbalances -- common as menopause approaches -- are frequent culprits.

Treatments are available for each of these conditions. Treatment options range from hormonal manipulation (birth control pills, synthetic or natural progesterone, Lupron) to surgery (D&C, endometrial ablation, resection of fibroids, hysterectomy). Just accepting such bleeding is not, in my opinion, an option! If your gynecologist is not interested in investigating this bleeding completely, find one who will.