I have been told I have endometriosis. My menstrual problems started as soon as I reached puberty. After my first normal period I then bled for long periods, up to four weeks at a time, on and off for a period of about 10 months. The bleeding was also incredibly heavy with excessive clotting and great pain. Eventually I was given a blood transfusion and a D&C. The pain wasn't cured, but my periods returned to a normal monthly cycle. Do you know of other cases where the onset has been so dramatic? Is this typical?

B.T.

During the first few years following menarche (the first period), most women do not ovulate each and every month. When there is no ovulation, the ovary does not then produce progesterone, as it normally does after ovulation. Progesterone stabilizes the growth of the uterine lining, prevents overgrowth, and programs the menstrual bleed to begin about two weeks after ovulation. Without ovulation and progesterone, the result can be uncontrolled, unsynchronized growth of the uterine lining, which can often lead to heavy or prolonged menses.

In a case such as this, if a woman's cycles do not regulate, her physician should check for pregnancy complications, infection, bleeding disorders and polycystic ovary syndrome, any of which could also cause abnormal bleeding such as you described.

While women who have pain before menstruation may have endometriosis, cramping associated with heavy flow does not in itself necessarily suggest endometriosis. Unless there are other reasons your doctor diagnosed this condition, I would assume the cramping was due to the heavy flow and clotting, and I would focus my attention on treating the abnormal bleeding and anovulatory periods.