Heavy menstrual bleeding, also known as menorrhagia, is characterized by abnormally heavy or prolonged menstrual periods. This can significantly impact a woman’s quality of life and potentially lead to anemia. Understanding what constitutes normal blood loss during menstruation is crucial for identifying potential problems and seeking appropriate medical advice.
Identifying Heavy Menstrual Bleeding: Signs and Symptoms
How do you know if you are experiencing heavy menstrual bleeding? Look out for these signs and symptoms:
- Frequent changes: Needing to change your tampon or pad every two hours or less.
- Soaking through protection: Experiencing menstrual flow that saturates one or more pads or tampons every hour for several consecutive hours.
- Using multiple pads: Needing to use double pads to manage menstrual flow.
- Nighttime changes: Waking up during the night to change pads or tampons.
- Prolonged periods: Menstrual periods lasting longer than seven days.
- Large blood clots: Passing blood clots that are the size of a quarter or larger.
- Impact on daily life: Experiencing heavy menstrual flow that prevents you from participating in normal activities.
- Pelvic pain: Constant pain in the lower abdomen during periods.
- Fatigue and weakness: Feeling tired, lacking energy, or experiencing shortness of breath.
If you experience these symptoms, it is crucial to consult a healthcare provider.
Who is at Risk of Heavy Menstrual Bleeding?
Heavy menstrual bleeding is a prevalent issue, affecting over 10 million American women annually, which translates to approximately 1 in 5 women. It is one of the most frequent concerns reported to healthcare providers by women.
What Causes Heavy Menstrual Bleeding?
In many cases, the underlying cause of heavy menstrual bleeding remains unidentified. However, it’s essential to investigate potential bleeding disorders, even if routine gynecological exams are normal.
Bleeding Disorders:
- Von Willebrand disease (VWD)
- Platelet function disorders
- Other bleeding disorders
Uterine-Related Problems:
- Non-cancerous growths or tumors in the uterus, such as uterine fibroids or polyps.
- Uterine or cervical cancer.
- Certain forms of birth control, such as intrauterine devices (IUDs).
Pregnancy-Related Problems:
- Miscarriage: The loss of a fetus in the womb.
- Ectopic pregnancy: A dangerous condition where a fetus begins to develop outside the uterus.
Hormone-Related Problems:
- Conditions like polycystic ovarian syndrome (PCOS) can lead to hormonal imbalances and irregular, prolonged periods.
Medications:
- Certain medications, such as aspirin or anticoagulants (blood thinners), can contribute to heavy menstrual bleeding.
Testing and Diagnosis for Heavy Menstrual Bleeding
alt: Diagram illustrating uterine polyps and fibroids within the female reproductive system, highlighting potential causes of heavy menstrual bleeding.
Diagnosing heavy menstrual bleeding can be challenging, as individual perceptions of “heavy bleeding” vary. Typically, menstrual bleeding lasts about 4 to 5 days, with a blood loss of approximately 2 to 3 tablespoons. Women experiencing heavy menstrual bleeding often bleed for more than 7 days and lose twice as much blood.
If bleeding exceeds 7 days per period or necessitates changing pads or tampons almost hourly, seek medical advice. Healthcare providers will inquire about medical history and menstrual cycles, including:
- Age at the onset of menstruation.
- Length of the menstrual cycle.
- Usual duration of the period.
- Number of days with heavy flow.
- Impact of periods on quality of life.
They may also ask about family history of heavy menstrual bleeding and may have you complete a questionnaire to help determine if you need to be tested for a possible bleeding disorder.
Tracking menstrual cycles, including period dates and flow intensity (pad/tampon usage), is beneficial before consulting a healthcare provider.
alt: Better You Know Menstrual Chart and Scoring System for monitoring and quantifying menstrual flow and cycle patterns.
Healthcare providers may also conduct a pelvic exam and recommend additional tests to identify the cause of heavy menstrual bleeding.
Diagnostic Tests
The following tests might be recommended to identify potential bleeding problems:
- Blood test: Checks for anemia, thyroid issues, or blood clotting abnormalities.
- Pap test: Screens for infections, inflammation, or abnormal cervical cells.
- Endometrial biopsy: Evaluates the uterine lining for cancer or abnormal cells.
- Ultrasound: Uses sound waves to visualize blood vessels, tissues, and organs.
Additional tests may include:
- Sonohysterogram: An ultrasound performed after injecting fluid into the uterus to detect uterine lining issues.
- Hysteroscopy: Visual examination of the uterus’s interior using a small instrument to identify fibroids, polyps, or other bleeding causes.
- Dilation and curettage (D&C): A procedure involving the removal of the uterine lining.
Treatment and Recovery Options for Heavy Menstrual Bleeding
Heavy menstrual bleeding is a widespread condition with available treatments. Open communication with a healthcare provider is essential for accurate diagnosis and appropriate treatment.
Treatment approaches depend on the cause and severity of bleeding, as well as individual factors such as age, overall health, medical history, treatment preferences, and reproductive goals.
Treatment options may be ongoing or one-time procedures. Discuss all available options with your healthcare provider to determine the best course of action.
Drug Therapy
- Iron supplements: Replenish iron levels to address anemia.
- Ibuprofen (Advil): Alleviates pain, menstrual cramps, and reduces bleeding.
- Birth control pills: Regulate periods and reduce bleeding.
- Intrauterine contraception (IUC): Regulate periods and reduce bleeding through drug-releasing devices placed into the uterus.
- Hormone therapy (estrogen and/or progesterone): Reduces bleeding.
- Desmopressin nasal spray (Stimate®): Controls bleeding in certain bleeding disorders by releasing clotting proteins.
- Antifibrinolytic medicines (tranexamic acid, aminocaproic acid): Reduces bleeding by preventing clot breakdown.
Surgical Treatment
- Dilation and curettage (D&C): Removes the top layer of the uterine lining to reduce menstrual bleeding.
- Operative hysteroscopy: Surgical procedure using a special tool to view the inside of the uterus, that can be used to help remove polyps and fibroids, correct abnormalities of the uterus, and remove the lining of the uterus to manage heavy menstrual flow.
- Endometrial ablation or resection: Removes all or part of the uterine lining to control menstrual bleeding.
- Hysterectomy: Surgical removal of the entire uterus, resulting in the cessation of menstruation and the inability to become pregnant.
