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Heavy Menstrual Flow: “My Period is Heavy…But What’s ‘Too Heavy’?”

Heavy menstrual periods (medically termed ‘menorrhagia’) is a common GYN concern, and a frequent reason for women visiting their doctors.  10-35% of women report heavy menstrual periods in population-based studies.  Though patients may not know the clinical definition of menorrhagia, I believe them when they report ‘heavy periods’… (based on relative changes in their flow compared to when their period was more ‘normal’…or based on their perception of the flow being ‘heavier than normal’.)

Menorrhagia is clinically defined as menstrual flow lasting longer than 7 days…or greater than 80ml (5-6 tablespoons) blood flow…but who really knows how to measure blood flow that way? Admittedly, for both patients and physicians, blood loss is difficult to quantitate by these measures.  More relevant descriptions of heavy menstrual flow may include

Heavy menstrual periods (medically termed ‘menorrhagia’) is a common GYN concern, and a frequent reason for women visiting their doctors.  10-35% of women report heavy menstrual periods in population-based studies.  Though patients may not know the clinical definition of menorrhagia, I believe them when they report ‘heavy periods’… (based on relative changes in their flow compared to when their period was more ‘normal’…or based on their perception of the flow being ‘heavier than normal’.)

Menorrhagia is clinically defined as menstrual flow lasting longer than 7 days…or greater than 80ml (5-6 tablespoons) blood flow…but who really knows how to measure blood flow that way? Admittedly, for both patients and physicians, blood loss is difficult to quantitate by these measures.  More relevant descriptions of heavy menstrual flow may include:

  • Soaking through a pad or tampon every 1-3 hours on your heaviest days
  • “Doubling up” on pads or tampons to prevent soiling your clothing
  • Needing to change pads at night to prevent soiling clothing, bedding
  • Heavy flow, along with passing blood clots
  • Iron-deficient anemia (low red blood cell count)

So why is the period so heavy?  There’s not just one reason.  Of the identifiable causes for heavy menstrual flow, reasons vary…as does the likelihood of their occurrence (based on the particular age-range of the patient.)  The most common causes include:

 

  • Anovulation--irregular hormonal flow, resulting in abnormal menstrual flow (affects teens/menstruating women)
  • Structural abnormalities—abnormal growths within the uterus, such as fibroids/polyps (more likely in menstruating/postmenopausal women)
  • Bleeding abnormalities—conditions which affect our body’s bleeding/blood clotting system (rare, but usually diagnosed in teen years)

When evaluating you for heavy menstrual periods, your doctor may perform a pelvic exam, as well as, order blood tests and a pelvic ultrasound.  The blood tests are usually run to rule out anemia (low red blood cell count from heavy bleeding), a pregnancy test, and thyroid blood tests (occasionally thyroid disorders can contribute to menstrual changes.)  A pelvic ultrasound is done to look for anatomic changes in your uterus (fibroids, polyps.)  Your doctor may also recommend an endometrial biopsy (a sampling of the tissue from the lining of the uterus.)

In discussing treatment options with patients, I usually categorize the options into 4 options:

Watchful waiting--

  • Some changes in our flow are temporary, and over time correct themselves.  As long as the symptoms are stable, and not worsening, a trial of watch-and-wait is an option.

Medications--

  • Options in this category may include NSAID’s (like Motrin and Aleve.)  These medications are known to help with menstrual cramping, but many patients are not aware of their utility in decreasing menstrual flow as well.  The results may not be dramatic, but some improvement may be noticed.
  • OCP/Mirena IUD—both significantly effective in reducing menstrual blood flow and cramping

Minor Procedures--

  • Dilation and Curettage (D & C) with Hysteroscopy— a narrow camera (hysteroscope) is inserted         into the uterine cavity to visualize it’s anatomy, evaluating for endometrial polyps, fibroids or other abnormalities.  D&C uses a narrow curette to obtain a tissue sampling
  • Endometrial Ablation—procedures usually involving electrosurgical heat to cauterize the lining of the uterine cavity, resulting in significant decrease in menstrual flow (offered to women who have completed child-bearing)

Hysterectomy--

  • The surgical removal of the uterus, the most definitive solution when other treatment options have failed, for significant anatomical abnormalities (when child-bearing is completed)
  • Differing routes for surgical removal (abdominally, vaginally, laparoscopic assisted, or robotic assisted) will be recommended by your doctor based on size of the uterus, your history of previous pelvic surgery, and their surgical expertise

Consult your healthcare provider if you have concerns about your period being too heavy.  For more detailed information visit the American College of Obstetrics and Gynecology (ACOG) website at http://www.acog.org /search menorrhagia.

 

Suzanne Hall, MD (@drsuzyyhall)

Eastside Gynecology Obstetrics, PC


About the author

drsuzyyhall

Comments

What a great article!

Wednesday, 22 February 2012

Thanks Stacey! Hope you found it informative.

DrSuzyyHall

Friday, 24 February 2012

Excellent information Dr. Hall! Love the site :D

Sunday, 26 February 2012

Thanks, Michelle! We're trying to build a site that's fun to read, yet informative. Glad you're enjoying it!

Tuesday, 28 February 2012
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