Fixing Heavy Menstrual Bleeding; How Can We Solve This Problem?

Bad periods and menorrhagia affect 1 in 5 women.

During my periods, I soak through pads and tampons. I pass large clots. I miss work and school. If these scenarios apply to you, then you may suffer from menorrhagia.

Heavy bleeding (menorrhagia) is one of the most common problems women report to their doctors. It affects more than 10 million American women each year. This means that about one out of every five women suffers from this issue.

Menorrhagia is menstrual bleeding lasting more than seven days. It can also be bleeding, which is very heavy. How do you know if you have heavy bleeding? If you need to change your tampon or pad after less than 2 hours or you pass clots the size of a quarter or larger, that is heavy bleeding.

Heavy bleeding is relative. If the amount of bleeding and length of the menstrual cycle interferes with your lifestyle, then it is time to visit an Obgyn. We have many options to help women suffering from this type of bleeding.

Untreated heavy or prolonged bleeding can stop you from living your life to the fullest. It also can cause anemia. Anemia is a common blood problem leaving you feeling tired or weak. An untreated bleeding problem can lead to other health problems. Early treatment and intervention avoid complications like blood transfusions, dilation and curettage (D&C), or hysterectomy.

Causes

Possible causes fall into the following three areas:

Uterine-related problems

  1. Growths or tumors of the uterus that are not cancer; these can be called uterine fibroids or polyps.
  2. Adenomyosis
  3. Cancer of the uterus or cervix.
  4. Certain types of birth control
  5. Problems related to pregnancy, such as a miscarriage or ectopic pregnancy, can cause abnormal bleeding. A miscarriage is when an unborn baby (also called a fetus) dies in the uterus. An ectopic pregnancy is when a baby starts to grow outside the womb (uterus), which is not safe.

Hormone-related problems

  1. Polycystic ovarian syndrome
  2. Ovulation disorders
  3. Thyroid disease

Other illnesses or disorders

  1. Bleeding-related disorders, such as von Willebrand disease (VWD) or platelet function disorder.
  2. Nonbleeding-related disorders such as liver, kidney, or thyroid disease; pelvic inflammatory disease; and cancer.

Photo by cottonbro Canva

You may exhibit the following symptoms

You might have menorrhagia if you:

  • Have a menstrual flow that soaks through one or more pads or tampons every hour for several hours in a row.
  • Need to double up on pads to control your menstrual flow.
  • Need to change pads or tampons during the night.
  • Have menstrual periods lasting more than 7 days.
  • Have a menstrual flow with blood clots the size of a quarter or larger.
  • Have a heavy menstrual flow that keeps you from doing the things you would typically do.
  • Have constant pain in the lower part of the stomach during your periods.
  • Feel tired, lack energy, or are short of breath.

Diagnosing Menorrhagia

With heavy periods the patient is always right. If a patient feels her period is too heavy or interfering with her lifestyle, then we want to know. Obgyns should listen to the patient.

Defining heavy menstrual bleeding is not always easy because each person might think of “heavy bleeding” differently. Usually, menstrual bleeding lasts about 4 to 5 days, and the amount of blood lost is small (2 to 3 tablespoons).

However, women who have menorrhagia usually bleed for more than seven days and lose twice as much blood. If you have bleeding that lasts longer than seven days per period or is so heavy that you have to change your pad or tampon nearly every hour, you need to talk with your doctor.

To find out if you have menorrhagia, your doctor will ask you about your medical history and menstrual cycles.

He or she may ask you questions like the following:

  • How old were you when you got your first period?
  • How long is your menstrual cycle?
  • How many days does your period usually last?
  • How many days do you consider your period to be heavy?
  • How do your periods affect your quality of life?

Your doctor may also ask if any of your family members have had heavy menstrual bleeding. He or she may also have you complete a questionnaire to help determine if testing for a possible bleeding disorder is needed.

You might want to track your periods on a menstrual calendar by writing down the dates of your periods and how heavy you think your flow is (maybe by counting how many pads or tampons you use). Do this before you visit the doctor to give the doctor as much information as possible.

Photo by STIL on Unsplash

Possible Tests

Your doctor might tell you that one or more of the following tests will help determine if you have a bleeding problem:

  • Blood test. In this test, your blood will be taken using a needle. It will then be looked at to check for anemia, problems with the thyroid, or problems with the way the blood clots.
  • Pap test. For this test, cells from your cervix are removed and then looked at to find out if you have an infection, inflammation, or changes in your cells that might be cancer or might cause cancer.
  • Endometrial biopsy. Tissue samples are taken from the inside lining of your uterus or “endometrium” to find out if you have cancer or other abnormal cells. You might feel as if you were having a bad menstrual cramp during this test. But, it does not take long, and the pain usually goes away when the test ends.
  • Ultrasound. Sonograms are a painless test using sound waves and a computer to show your blood vessels, tissues, and organs. Your doctor then can see how they are working and check your blood flow.

Using the results of these first tests, the doctor might recommend more tests, including:

  • Sonohysterogram. This ultrasound scan is done after fluid is injected through a tube into the uterus by way of your vagina and cervix. This lets your doctor look for problems in the lining of your uterus. Mild to moderate cramping or pressure can be felt during this procedure.
  • Hysteroscopy. This is a procedure to look at the inside of the uterus using a tiny camera to see if you have fibroids, polyps, or other problems that might be causing bleeding. You might be given drugs to put you to sleep (general anesthesia) or local anesthesia to numb the area.
  • Dilation and Curettage (D&C). This is a procedure to find and treat the cause of bleeding. During a D&C, the inside lining of your uterus is scraped and looked at to see what might be causing the bleeding. A D&C is a simple procedure. Most often, it is done in an operating room as an outpatient procedure.

Photo by Gustavo Fring Canva

Treatment

The type of treatment you get will depend on the underlying cause of your bleeding and how serious it is. Your doctor also will look at things such as your age, general health, and medical history. We also evaluate how well you respond to certain medicines, procedures, or therapies.

Most importantly, we want to understand your wants and needs. For example, some women do not want to have a period, some want to know when they can usually expect to have their period, and some want just to reduce the amount of bleeding.

Some women want to make sure they can still have children in the future. Others want to lessen the pain more than they want to reduce the amount of bleeding.

Some treatments are ongoing, and others are done once. You should discuss all of your options with your doctor to decide which is best for you. Following is a list of the more common treatments.

Drug Therapy

  • Iron supplements. To get more iron into your blood to help it carry oxygen if you show signs of anemia.
  • Ibuprofen (Advil). To help reduce pain, menstrual cramps, and the amount of bleeding. In some women, NSAIDs can increase the risk of bleeding.
  • Birth control pills. To help make periods more regular and reduce the amount of bleeding.
  • Antifibrinolytic medicines (tranexamic acid, aminocaproic acid). To reduce the amount of bleeding by stopping a clot from breaking down once it has formed.
  • Intrauterine contraception (IUC). To help make periods more regular and reduce the amount of bleeding through drug-releasing devices placed into the uterus.
  • Hormone therapy. Various hormonal medications are used to reduce the amount of bleeding.
  • Desmopressin Nasal Spray (Stimate®). To stop bleeding in people who have certain bleeding disorders, such as von Willebrand disease and mild hemophilia, by releasing a clotting protein or “factor,” stored in the lining of the blood vessels to help the blood to clot and temporarily increasing the level of these proteins in the blood.

Surgical Treatment

  • Dilation and Curettage (D&C). A procedure in which the top layer of the uterus lining is removed to reduce menstrual bleeding. This procedure might need to be repeated over time.
  • Operative hysteroscopy. A 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 the heavy menstrual flow.
  • Endometrial ablation. This type of surgical procedure destroys part of the lining of the uterus to control menstrual bleeding. Some patients will stop having menstrual periods altogether. Others may continue to have periods, but the menstrual flow will be lighter than before. Although the procedures do not remove the uterus, an ablation can not be performed if a woman desires children in the future.
  • Hysterectomy. A major operation requiring hospitalization that involves surgically removing the entire uterus. After having this procedure, a woman can no longer become pregnant and will stop having her period.

Menorrhagia is common among women. Many women do not know that they can get help for it. Others do not get help because they are too embarrassed to talk with a doctor about their problem. Talking openly with your doctor is very important in making sure you are diagnosed properly and get the right treatment.

Thank you to BeingWell for publishing this article on Medium.

This article was originally posted on Medika.life.

Blog Author: Dr. Jeff Livingston

Main Blog Photo by: Polina Zimmerman Canva

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