ObGyn Update: Are Heavy Periods Interfering with Your Normal Life?

A woman whose menstrual periods are so uncomfortable, frequent, or heavy as to interrupt her usual activities is not comforted by the fact that this is a very common women’s health problem. The medical name for abnormally heavy periods is menorrhagia. Although about a third of women experience this problem at some time, heavy bleeding is not normal. Changes in your normal menstrual cycle are always a reason to talk with your ObGyn. Besides being very disruptive to your life, heavy menstrual bleeding can sometimes signal a more serious problem.

Periods are considered “heavy” if…

  • They lasts more than 7 days.
  • You are soaking through one or more tampons or pads per hour (several times in a row).
  • You need more than one pad for protection.
  • You notice clots the size of a quarter or larger. Clots are caused by heavy flow.
  • You have to change pads or tampons during the night.

Heavy bleeding can lead to iron-deficiency anemia. Anemia is a shortage of red blood cells in your body. With severe anemia, you may experience shortness of breath, fatigue, or dizziness, and heart problems may develop.

Your doctor will recommend an exam, lab tests, and possibly other diagnostic procedures to determine the cause of your heavy periods.

  • Frequently, uterine fibroids or polyps are the source of the problem.
  • Adenomyosis—a condition where the uterine lining grows into the muscle layer below it—also causes heavy periods.
  • Irregular ovulation (the release of an egg from the ovary) can allow the lining of the uterus to become too thick in some places. As the uterus sheds its lining, your period will be heavier. This sometimes occurs as you approach menopause.
  • Heavy bleeding can be a sign of endometrial cancer (cancer of the uterine lining).
  • Other possible causes include endometriosis, polycystic ovary syndrome, ectopic pregnancy or miscarriage, a copper IUD, or pelvic inflammatory disease.
  • Sometimes the cause is not related to the reproductive organs. (ex. hypothyroidism, a bleeding disorder or a blood thinning medication).

After ruling out serious medical problems, your doctor can offer a number of choices to control your heavy periods. This is not something a woman just has to live with. The first choice is usually a medication, typically a hormonal birth control pill or hormonal IUD. Hormone replacement therapy may be a choice during perimenopause (the time approaching menopause). Gonadotropin-releasing hormone (GnRH) agonists may be used to stop menstrual periods and shrink fibroids, but this is a temporary option (6 mos. or less). Fibroids will usually enlarge again when the medication is stopped. Other medications may also be helpful.

If medication does not provide enough relief, a surgical procedure is an option. If fibroids are causing the heavy periods, myomectomy—a surgical procedure to remove fibroids—can be helpful to women who may still want to have a pregnancy. Endometrial ablation is a minimally-invasive surgical procedure. It uses heat to destroy the lining of the uterus. Ablation is effective in selected patients, but in some cases heavy bleeding or cyclic pain may return. It is not an option for women who may want a future pregnancy. But women choosing this procedure will still need to use birth control because endometrial ablation is not a sterilization procedure. Inserting a hormonal IUD will also produce very light periods or eliminate them entirely. It offers the advantages of birth control and while preserving the possibility of future pregnancy. For some women, hysterectomy—surgery to remove the uterus—may be the best choice. While hysterectomy is a somewhat larger surgery than endometrial ablation, it is still almost always a minimally-invasive procedure. It guarantees that periods will not return. No future pregnancy is possible.

If you dread your monthly period because heavy bleeding disrupts your ability to meet your responsibilities and enjoy normal activities, talk with your gynecologist. Above all, we want to be sure no serious health condition is the cause. And, as you can see, we have many options to “keep you in the game” every day of the month.