As a teenager, waiting for your very first period felt like an eternity. You wondered, read all the books, and were excited. But it didn’t take you long to discover that having a period wasn’t all that much fun. While the process is clockwork for some women—arriving every 28 days without fail, always 7 days long and hardly even a cramp to speak of, there are other women who experience something much different. Basing the process almost entirely on the rise and fall of specifically timed, precise female hormones, your menstrual cycle is a complex and perfectly coordinated process. But when that process changes, so do your periods and you end up with heavy, long or irregular bleeding—a condition we call dysfunctional uterine bleeding.

How would I know if I had dysfunctional uterine bleeding?

Dysfunctional uterine bleeding is a blanket term for a variety of symptoms and problems related to your period. For some women, it’s a timing problem with a period that comes whenever it feels like it—twice a month, or skips several weeks. Most commonly women with dysfunctional bleeding complain of having their period more frequently than every 28 days, but you may still fall into the category if your cycles are more than 35 days apart or if they start at a different time each month.

In addition, many women experience heavier than normal bleeding during their periods. Passing clots, changing pads at night, and soaking at least one pad or tampon every hour for 2-3 hours in a row are all signals from your body that may need attention from a doctor. Women who have dysfunctional uterine bleeding may have all of these conditions in combination and in any form—just as you are unique, so is your period.

How can my bleeding problems be treated?

Before treating your bleeding, your doctor may want to do some blood work, he or she will complete a pelvic exam and maybe a pap smear or cultures to help find any signs of infection or structural problems (like a tumor, fibroid, polyp or cyst) that could be causing your bleeding issues. To get a better picture of what’s happening inside your uterus, you may also have an ultrasound if your doctor feels it’s necessary before recommending treatment.

Medications

Menstrual irregularities like heavy or irregular bleeding are relatively common among women and can many times be treated with simple hormonal medications. Low-dose birth control pills, progesterone only pills, and IUD’s that release progestin-type hormones can help significantly. Sometimes taking anti-inflammatory medications like ibuprofen and acetaminophen in the days leading up to your period may be helpful as well. Your doctor will help you choose a method that is right for you.

Procedures

If standard treatments aren’t successful in relieving your symptoms, you may be a candidate for surgical intervention.

A hysteroscopy, to look inside the uterus, combined with a D&C to scrape down the inside of the uterus and clean out the bleeding tissue may also be helpful in controlling symptoms.

If you have completed your child bearing, an endometrial ablation—or procedure that destroys the lining of the uterus— is often helpful in controlling heavy bleeding. With very few side effects, an ablation causes many women to have a lighter period, or no period at all. This method does make it impossible to get pregnant though—so if you are trying to have a baby this method isn’t for you.

A hysterectomy may even be considered if bleeding is heavy enough to cause anemia and fatigue. Newer methods use minimally invasive techniques that make hysterectomy easier and recovery much shorter.