Bleeding worth evaluating
- Soaking a pad or tampon every hour or two
- Periods lasting longer than seven days
- Cycles shorter than 21 days or longer than 35
- Bleeding between periods or after intercourse
- Passing clots larger than a quarter
The most common causes
Hormonal shifts from PCOS, thyroid dysfunction, or perimenopause account for a large share of irregular cycles. Structural causes like fibroids and polyps tend to produce heavy but predictable bleeding. Birth control changes, significant weight change, endurance training, and stress all shift timing.
Pregnancy is always on the list, and it's the first thing we rule out with a test at the visit.
What we check
Our on-site labs at both Fresno locations run a CBC and ferritin to look for iron-deficiency anemia, a thyroid panel, and hormone testing where it's useful. Heavy periods are a common cause of iron deficiency, and the fatigue, hair shedding, and breathlessness that come with it are frequently blamed on stress for years before anyone checks a ferritin.
If we suspect fibroids or polyps, we coordinate pelvic ultrasound and gynecology referral. If flank pain or urinary symptoms muddy the picture, our digital X-ray at the Shields & Palm location helps sort a kidney stone from a gynecologic cause the same day.
How it's managed
Treatment depends on cause and on whether you want pregnancy soon. Hormonal contraception, tranexamic acid for heavy days, iron repletion, and thyroid correction all have a role, and often more than one is used together.
Workups for cycle changes run through our women’s health services with bloodwork at our on-site labs; if you are trying to conceive, see preconception planning.
Come to urgent care for:
- Heavy bleeding leaving you lightheaded or exhausted
- Bleeding between periods or after sex
- Missed periods with a negative home test
- Cycle changes plus fatigue, hair loss, or weight change
Go to the ER (or call 911) for:
- Soaking through a pad an hour for two or more hours
- Fainting, chest pain, or severe shortness of breath
- Severe one-sided pelvic pain with a positive pregnancy test
Frequently asked
How heavy is too heavy?
Soaking a pad or tampon hourly, needing double protection, or passing clots larger than a quarter all qualify as abnormally heavy and deserve a workup.
Can stress alone stop my period?
Yes, significant stress, weight change, or heavy training can suppress ovulation. We still rule out thyroid disease and pregnancy before calling it stress.
Will you check for anemia?
Yes — a CBC and ferritin are standard for heavy bleeding, drawn on site at your visit.
Could this be PCOS?
Irregular cycles with acne, unwanted hair growth, or weight gain raise the question. We can check androgens, glucose, and A1c to work it up.
Do I need an ultrasound?
Often, if fibroids or polyps are suspected. We arrange the imaging and read the results with you afterward.
Is spotting on birth control normal?
In the first three months of a new method, usually. Persistent spotting after that is worth a visit — sometimes it's just the wrong formulation for you.