I have been having a period for two months. I went to the doctor but they cannot find anything wrong. Should I worry?

--C.S.

Bleeding for two months is always reason for concern -- and a trip to your gynecologist. There are many, many reasons for such bleeding, ranging from infection to uterine polyps to fibroids to pregnancy to hormone imbalance. Your age plays a role in deciding how to proceed with the investigation, but in general, tests may include any of the following:

• CBC (complete blood count). This will show whether you are anemic.
  
• TSH. This blood test evaluates the thyroid gland. An underactive or overactive thyroid may cause abnormal bleeding.
  
• Cultures to detect bacterial infection. Chronic low-grade uterine infection may produce prolonged spotting or bleeding.
  
• Pregnancy test. This is an absolute must-do test for all but the menopausal or women who have had hysterectomies.
  
• Bleeding time. Your doctor may do this and other tests to measure the blood's ability to clot properly. Often women with a clotting abnormality like von Willibrand's disease will give a history of lifelong heavy periods and easy bruising.
  
• Ultrasound. Either a traditional ultrasound or the new saline infusion ultrasound may be done to look for ovarian cysts, fibroids, polyps or a thickened uterine lining.
  
• Endometrial biopsy. The doctor inserts a small catheter into the uterus to obtain a sample of the lining for analysis. This test is done in the office and causes moderate cramping.
  
• D&C. This surgical procedure samples the uterine lining and is more extensive than an endometrial biopsy. It may be combined with a hysteroscopy, a surgical procedure that involves inserting a telescope-like instrument through the cervix to view the uterine cavity.
  

Sometimes all tests are normal. Prolonged bleeding may be a sign of impending menopause. In this case, using progesterone may help to regulate the bleeding. Obviously, if a particular abnormality is diagnosed, it would be treated specifically. Your gynecologist should be able to determine what tests are needed and perform them.