Menorrhagia

Many women experience heavier or longer periods than usual. This used to be called menorrhagia. While many women have periods that are a bit heavier than others, it's important to know that significant blood loss during a period is not normal.

Sometimes, periods come earlier or later than expected, or there's bleeding between periods. This is called irregular or abnormal uterine bleeding.

Heavy periods can make it tough to go about your daily life. The flow and cramps can be quite uncomfortable, making it harder to do everyday things. If your period makes you anxious or uncomfortable due to heavy bleeding, talk to your doctor. There are various treatments available to help manage this.

Heavy menstrual bleeding can cause a lot of discomfort and affect your daily life. It's important to recognize the symptoms so you can talk to your doctor.

Heavy bleeding is typically defined as soaking through one or more pads or tampons every hour, or needing extra protection to manage the flow. This can happen for several hours straight. You might also need to change your protection more often, even during the night. Periods lasting longer than a week are also a sign of potential issues.

Blood clots larger than a quarter are another possible symptom. Heavy bleeding can make it difficult to carry out your usual activities, and you might feel tired, weak, or short of breath.

If you experience any of these symptoms, it's important to seek medical attention. This includes:

• Heavy bleeding: If you're soaking through a pad or tampon every hour for more than two hours, contact your doctor. This is a significant sign of heavy bleeding and should not be ignored.
• Bleeding between periods or unusual bleeding: Any bleeding outside of your regular period could be a sign of a problem. This includes spotting or bleeding that's different from your normal cycle.
• Bleeding after menopause: If you experience any vaginal bleeding after menopause, it's crucial to see a doctor immediately. This is not normal and requires medical evaluation.

In short, if you're concerned about your menstrual bleeding, don't hesitate to reach out to your doctor. They can help determine the cause and recommend appropriate treatment.

If you have any of these concerns before your next scheduled exam, see a doctor right away:

• Heavy bleeding: If you're bleeding through a pad or tampon every hour for more than two hours straight, this is a serious issue that needs immediate attention. This could be a sign of a problem requiring medical care.

• Bleeding between periods or unusual bleeding: If you're bleeding when you're not supposed to be, or if the bleeding is different from your usual pattern, it's important to get it checked out. This could be a sign of something that needs medical attention.

• Bleeding after menopause: If you've reached menopause and are experiencing vaginal bleeding, this is not normal and requires immediate medical attention. Menopause typically means the end of monthly periods, so any bleeding after this transition needs to be evaluated by a doctor.

Important Note: This information is for general knowledge and does not constitute medical advice. Always consult with a healthcare professional for any health concerns.

Understanding Heavy Menstrual Bleeding: Causes and Types

Heavy or irregular menstrual bleeding can be concerning, but it's often treatable. Several factors can contribute to this issue. This article explains some common causes.

Types of Uterine Problems

The uterus, or womb, can develop various growths that can impact menstrual flow. Here are a few key types:

• Fibroids: These are non-cancerous growths that develop in the uterus's muscular wall. There are three main types:

  • Intramural: These fibroids grow within the uterine muscle.
  • Submucosal: These fibroids grow into the uterine cavity, the space inside the uterus.
  • Subserosal: These fibroids grow outside the uterus. Sometimes, these types (submucosal and subserosal) are "pedunculated," meaning they have a stem or stalk that attaches them to the uterus.

• Uterine Polyps: These are small, benign (not cancerous) growths that attach to the uterine lining. They can vary in size and often cause irregular bleeding patterns, including spotting between periods, heavier periods, or bleeding after menopause.

• Adenomyosis: In this condition, the tissue that normally lines the uterus (called the endometrium) grows into the uterine muscle. This can lead to heavy bleeding and painful periods.

Common Causes of Heavy Bleeding

Heavy menstrual bleeding can have various causes. Here are some of the most common:

• Hormonal Imbalance: Estrogen and progesterone work together to control the buildup and shedding of the uterine lining (endometrium). When these hormones are out of balance, the lining can become too thick, leading to heavy periods or spotting between periods. Factors like obesity, insulin resistance, thyroid problems, and polycystic ovary syndrome (PCOS) can disrupt this balance.

• Ovarian Problems: Sometimes, the ovaries don't release an egg during the menstrual cycle (anovulation). This affects hormone production, potentially leading to heavy or irregular bleeding.

• Uterine Fibroids: As mentioned earlier, these benign tumors can disrupt normal menstrual flow, resulting in heavier or prolonged bleeding.

• Uterine Polyps: These growths can also cause heavy or prolonged bleeding, including spotting between periods or after menopause.

• Adenomyosis: This condition, where endometrial tissue grows into the uterine muscle, can cause heavy menstrual bleeding and painful periods.

• Intrauterine Device (IUD): Some IUDs, particularly those without hormones, can sometimes cause heavier periods as a side effect. Discuss other birth control options with your doctor. Hormonal IUDs might help lessen heavy bleeding.

• Pregnancy Complications: Heavy bleeding during pregnancy can be a sign of a miscarriage or a condition called placenta previa, where the placenta (which nourishes the baby) is located too low in the uterus or covers the cervix.

• Cancer: In rare cases, abnormal uterine bleeding can be a symptom of uterine or cervical cancer. If you have concerns, it's crucial to see a doctor. A history of abnormal Pap tests is a risk factor for cervical cancer.

• Genetic Bleeding Disorders: Some genetic conditions, like von Willebrand's disease, can impact blood clotting and lead to heavy periods.

• Medications: Certain medications, including some birth control pills, blood thinners (like warfarin, enoxaparin, apixaban, and rivaroxaban), and others, can sometimes cause heavier or prolonged periods.

• Other Medical Conditions: Problems with the liver, kidneys, or thyroid can also affect menstrual cycles and cause heavy bleeding.

Important Note: If you're experiencing heavy or irregular bleeding, it's essential to consult a doctor. They can properly diagnose the underlying cause and recommend the best course of action.

Menstrual irregularities can happen for various reasons, and the causes often depend on a person's age and health. Normally, when an egg is released from the ovaries, the body produces progesterone. This hormone helps keep your periods regular. If an egg isn't released, the body doesn't make enough progesterone. This can lead to heavier periods or bleeding between periods.

For teenagers, irregular periods or heavy bleeding are commonly linked to the body not releasing an egg during its monthly cycle. This is especially common during the first year after a girl's first period, as the body is still adjusting.

In older women, heavy bleeding is often due to problems within the uterus. These issues can include growths like fibroids or polyps, or a condition called adenomyosis, where the uterine lining grows into the muscle of the uterus. However, other factors can also cause heavy bleeding. These could include uterine cancer, blood clotting disorders, side effects from certain medications, or liver or kidney problems. It's important to remember that there are many possible causes, and seeing a doctor is crucial for proper diagnosis and treatment.

Heavy or prolonged menstrual bleeding can sometimes lead to other health problems.

Painful Periods: If you have heavy bleeding, you might also have very painful menstrual cramps. This is called dysmenorrhea. If your cramps are so bad they interfere with your daily routine, it's important to talk to your doctor.

Anemia: Heavy bleeding can cause a condition called anemia. Anemia happens when your body doesn't have enough red blood cells. Red blood cells carry oxygen throughout your body. The amount of red blood cells is measured by a substance called hemoglobin. Hemoglobin is a protein in red blood cells that carries oxygen to all the tissues in your body.

When you don't have enough red blood cells, your body doesn't get enough oxygen. This can make you feel tired and give you headaches. While diet can play a part in iron deficiency anemia, heavy periods can make the problem significantly worse by causing extra blood loss. This blood loss depletes the body's iron stores, which are needed to make red blood cells.

Understanding Tests for Heavy or Irregular Bleeding

Heavy or unusual menstrual bleeding can be concerning. Doctors use several tests to find the cause and recommend the best treatment. These tests are usually part of a process, beginning with a conversation about your medical history and menstrual cycle.

Initial Tests

One of the first steps is to understand your menstrual cycle. You might be asked to keep a record of your periods, noting how long they last, how heavy your flow is, and how many pads or tampons you use.

Your doctor or healthcare provider will perform a physical exam. Based on this, they may recommend some initial tests, such as:

• Blood Tests: A blood sample can check for iron deficiency anemia, a common cause of heavy bleeding. It can also look for other problems like thyroid issues or blood clotting disorders.

• Pap Test: This test collects cells from your cervix (the opening of your uterus). It checks for inflammation or changes that could be precancerous (meaning they might become cancerous). The test also checks for the human papillomavirus (HPV) in women aged 25 and older.

• Endometrial Biopsy: A small tissue sample is taken from the lining of your uterus (endometrium). A doctor specializing in lab analysis (a pathologist) examines the sample for signs of cancer or precancer.

• Ultrasound: Ultrasound uses sound waves to create images of your uterus, ovaries, and pelvis. This helps visualize the structures and identify any abnormalities.

Further Tests (if needed)

If the initial tests don't fully explain the bleeding, further tests might be recommended:

• Sonohysterography: A special ultrasound test. A small amount of fluid (saline) is injected into your uterus through your vagina and cervix. This allows for a clearer view of the uterine lining, helping to identify potential problems.

• Hysteroscopy: A thin, lighted tube (hysteroscope) is inserted into your uterus through your vagina and cervix. This allows your doctor to directly view the inside of the uterus, offering a detailed look at the uterine walls.

Diagnosis and Causes

It's important to remember that heavy or irregular bleeding isn't always a sign of a serious problem. Your doctor will consider various factors in making a diagnosis. These factors might include:

• Menstrual disorders: Some women have conditions that affect their menstrual cycles.
• Medical conditions: Other health issues can cause bleeding problems.
• Medications: Certain medicines can impact the menstrual cycle.

Only after ruling out other possible causes can your doctor confidently diagnose heavy or abnormal uterine bleeding.