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    by Ngozi Osuagwu, MD | March 19th, 2017


    By the time you finish reading this blog, you will know. Your menstrual cycle can be the window to helping us find out if you have any other problems. When you come in for your annual exam and we ask about your period, we want to make sure that it is normal.

    A normal period usually comes about every 24 – 38 days (from the first day of one period to the first day of the next period) and last from 4 – 8 days. It might become more irregular as you get closer to menopause but it should not last longer than 8 days.

    If your bleeding is abnormal or you feel that the bleeding is so heavy where you are having accidents at work or if you are in so much pain that you are not functional at work, you need to have it checked out – this is where PALM-COEIN comes to play. When you talk to your health care provider, they are thinking of the cause of your abnormal bleeding with this mnemonic – PALM-COEIN.

    PALM –COEIN stands for:

    Problems with the structure of the uterus – usually an ultrasound will help with the diagnosis.

    Polyps – may cause bleeding in between your period or bleeding after sex.

    Adenomyosis – when the cells that are found in the lining of the uterus are found in the muscle of the uterus. It can be associated with painful periods.

    Leiomyomas – another name for fibroids- about 70 % of women will be diagnosed with fibroids by the time they are 50 years old. Fibroids may or may not cause symptoms.

    Malignancy – I have mentioned it on previous blogs, unlike the mammogram for breast cancer or the pap smear for cervical cancer, we do not have a screening test for endometrial cancer. The screening test for endometrial cancer is your history. Not all abnormal bleeding is due to cancer, but we need to check to make sure your abnormal bleeding is not.

    Not related to the structure of the uterus – will need blood work.

    Coagulopathy – problems with the clotting factors in your blood – very common in young people having abnormal bleeding.

    Ovulatory Dysfunction – not ovulating every month – this can really cause you to skip many months without a period. If you have gone three months without a period and you are not close to the age of menopause, you should talk with your doctor. There are many reasons why women do not ovulate for example, thyroid disease.

    Endometrial Causes – An example could be an infection.

    Iatrogenic – Sometimes the medicines that are prescribed by the doctor can cause abnormal bleeding.

    Not Yet Classified – Sometimes the reasons do not fit in a clear category or are not known.

    Bottom line: Know the first day for your last menstrual period. Be prepared when you see your doctor. If you believe that your periods are not normal, start recording your bleeding pattern. You can write it on paper or start using the calendar on your phone. It might take time to find the cause. As you can see from above, finding the cause of abnormal menstruation may not be as easy as you think.




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