Heavy menstrual bleeding is a common occurrence in women. About a third of women seek medical attention for this problem. Heavy menstruation isn’t normal. It may interfere with your entire life and could be an indication of a more severe health condition. If you have any worry that your menstrual bleeding is so heavy, contact an obstetrician-gynecologist as soon as possible.
At All Women’s Care, we cover a wide range of women’s health problems, including heavy menstrual bleeding. We have highly qualified obstetrician-gynecologists who will conduct various screening procedures to determine what exactly is causing your heavy bleeding. Additionally, they will consult with you on what medication suits you based on your condition. If you need an experienced gynecologist in Los Angeles, do not hesitate to call us for immediate help.
What is Heavy Bleeding?
Heavy bleeding is medically defined as passing over 80ml of blood every time you undergo menstruation. It is a description of losing menstrual blood in excessive, which, in turn, disrupts the quality of life of a woman. Since it is usually impractical to measure blood loss, physicians rely on a patient’s description of their menstrual cycle to determine if it is excessive bleeding.
Studies indicate that heavy bleeding affects 3% of women in America. Those aged between 40 and 51 years old are the ones likely to present their cases to healthcare services. Heavy bleeding is not pregnancy-related. Additionally, it only happens during the reproductive years of a woman; that is, it is not postmenopausal.
Many heavy bleeding cases (about 40% to 60%) can’t be linked to any endocrine, uterine, or hematological pathology after being investigated. Initially, these cases were known as Dysfunctional Uterine Bleeding as an excluded diagnosis. However, today, the term Abnormal Uterine Bleeding is used.
Symptoms of Heavy Bleeding
Signs and symptoms of heavy bleeding may include:
- Bleeding for more than one week
- Changing your sanitary pads more frequently than four times daily
- The need to wake up at night and change your sanitary protection
- The need to use two sanitary pads simultaneously to control menstrual flow
- Soaking through more than one tampons or sanitary pads each hour for several consecutive hours
- Passing clots of blood, which are bigger than one quarter
- Anemic symptoms like tiredness, shortness of breath, or fatigue
- Restricting your daily activities like work, exercise, sports, travel, sexual intercourse, or recreational activities because of a heavy flow of menstrual blood
- Constant pain in the lower abdomen at the time of the menstrual periods
When You Should See a Physician
Seek medical attention before the next scheduled examination in case you experience:
- Irregular vaginal bleeding or bleeding between menstrual cycles
- Heavy vaginal bleeding that it soaks one tampon or pad at the minimum in one hour for over two hours
- Vaginal bleeding after undergoing menopause
Causes of Heavy Bleeding
In certain cases, what causes heavy bleeding is not known. However, several conditions can be linked to it. Common causes may include:
Ovary dysfunction- In certain cases, your ovaries may not ovulate (release an ovum/egg) during your menstrual cycle. In this case, your body does not produce the progesterone hormone as it would have during your regular cycle. This situation results in hormone imbalance, which may, in turn, result in heavy bleeding.
Hormone imbalance- For a regular menstruation cycle, a balance between progesterone and estrogen hormones controls the build-up of the uterine lining, which sheds during menstruation. To explain hormone imbalance, if you are not ovulating, it means no hormones are keeping the build-up in check. When ovulation finally occurs, the build-up of the uterus lining occurs in excess and sheds off all at once through heavy bleeding.
Several conditions can lead to hormone imbalances. These include insulin resistance, thyroid problems, obesity, and polycystic ovary syndrome (PCOS). PCOS affects between 5 and 10% of the women who are at childbearing age. In case you experience irregular and heavy periods, and at the same time have a high BMI or abnormal body hair, you could see an endocrinologist. An endocrinologist will test you for PCOS. Failing to ovulate may also be an indication that you have a thyroid disease. An endocrinologist can also identify this condition.
Fibroid tumors in the uterus- About 70 to 80% of women experience fibroids before they reach 50 years (childbearing years). While fibroid tumors are usually not cancerous, you must have your gynecologist check them out. Uterine fibroids can result in heavier than usual or prolonged menstruation periods. In other cases, they may be an indication that you are at a high risk of contracting sarcoma. Sarcoma is a rare yet deadly type of cancer. Often, fibroids will be evident during a pelvic exam. Another sign that you have fibroids is feeling pressure or pain in the abdomen where the fibroid tumor is located.
Polyps- Polyps refer to tiny, benign growths that occur on the uterus lining. They are commonly known as uterine polyps. Polyps may result in prolonged or heavy menstrual bleeding. They usually arise due to high levels of estrogen or infections and can be eliminated by conducting a minor surgical procedure. If you are spotting in between your cycles, it might indicate that you have got polyps.
Intrauterine device or IUD- Heavy menstrual bleeding is a common side-effect of using a non-hormonal IUD as a birth control method. If you experience heavy bleeding with IUD, you should inform your doctor as soon as possible. He/she will help you get an alternative option of birth control.
Adenomyosis- Adenomyosis arises when glands in the uterus become fixed in the muscles of the uterus. Often, this causes painful periods as well as heavy bleeding.
Pregnancy complications- If you experience a single, late, heavy period, it may be because of a miscarriage. Also, you may experience heavy bleeding in your pregnancy due to the unusual placenta location. For instance, you may have a placenta previa or low-lying placenta.
Cancer- Cervical and uterine cancer may lead to heavy menstrual bleeding. This is especially so if, previously, you had an abnormal test Pap. Heavy bleeding when you have cervical and uterine cancer also happens in postmenopausal women. In the early stages, if you have cancer, you may not experience several symptoms. But as the disease progresses, you may experience pain during sexual intercourse, abdominal pain, abnormal vaginal discharge, kidney damage, or weight loss. In this case, you may need to have a dilation & curettage. Or, your OBGYN may perform an endometrial biopsy procedure. These tests will rule cancer out as a possibility of heavy bleeding.
Endometriosis- Heavy bleeding may also occur due to endometriosis. Endometriosis is a condition whereby tissues in the uterus grows outside of the uterus into the pelvic cavity. Other signs of endometriosis are:
- Pain during sexual intercourse
- Severe menstrual cramps
- Difficulty with defecation
- Pain at the lower back during or before your period
It is quite hard to diagnose endometriosis, but it is crucial to identify it. This is especially so if you are planning on having children since it may result in infertility.
Medications- Certain drugs can cause prolonged or heavy menstrual bleeding. Examples of these drugs include:
- Anti-inflammatory drugs
- Hormonal medications like progestin and estrogen
- Anticoagulants like warfarin (Jantoven, Coumadin, or enoxaparin).
Inherited bleeding disorders- Heavy bleeding may be an indication that you have immune thrombocytopenia. This condition prevents the proper clotting of your blood. Also, in case you are suffering from this condition, you may experience nosebleeds and easy bruising. Heavy bleeding may also indicate that you have a bleeding disorder known as von Willebrand. This disorder results in the development of abnormal platelets, which prevent proper blood clotting. This is especially so in case the heavy periods began when you were below 18 years. Von Willebrand is the most common bleeding disorder to be inherited in the U.S. It is reported in about 5 to 24% of women that have chronically heavy bleeding. Usually, conducting blood tests may help to discover these disorders.
Pelvic Inflammatory disease (PID) - PID is an infection affecting reproductive organs. If it is not treated, this infection can result in heavy bleeding or infertility. Symptoms that may suggest you have PID are:
- Pain in the lower abdomen or stomach
- Difficulty with urination and intercourse
Other health conditions- Several other health conditions may result in heavy bleeding; for instance, kidney or liver disease.
Risk Factors for Heavy Bleeding
Risk factors that may result in heavy bleeding vary depending on age. They also vary depending on whether a person has any other health conditions that would explain the heavy bleeding. During a normal menstrual cycle, when the ovaries release an egg, it stimulates the body to produce progesterone. Progesterone is a female hormone responsible for maintaining a regular menstrual cycle. When the ovaries do not release an egg, inadequate progesterone production may lead to heavy bleeding.
Heavy bleeding in girls that are at their adolescent stage is usually because of anovulation. Girls at the adolescent stage are especially vulnerable to anovulatory menstrual cycles in their initial year after their first menstruation period.
In older women (who are still at their reproductive age), heavy bleeding is usually because of uterine pathology. Uterine pathology includes polyps, adenomyosis, and fibroids. However, other conditions like uterine cancer, side-effects of medication bleeding disorders, and kidney or liver disease should not be overlooked.
Complications Resulting From Heavy Bleeding
Prolonged or excessive menstrual bleeding could result in other health conditions, as will be discussed below.
Heavy or prolonged bleeding may lead to anemia due to blood loss. This is because heavy bleeding leads to a reduction in the number of circulating red blood cells (RBC). The number of circulating RBC is determined by hemoglobin. Hemoglobin is a protein that makes it possible for RBC to transport oxygen to the tissues. Anemia due to iron deficiency occurs since your body tries to recover the lost RBC by using the iron stores to generate more hemoglobin. Heavy bleeding may reduce the levels of iron in the body to the extent of increasing the chances of having iron deficiency anemia.
The symptoms of anemia include fatigue, weakness, and pale skin. Even though diet also causes iron deficiency anemia, heavy menstruation complicates the problem even further.
When having heavy bleeding, you may also experience painful menstrual cramps. Sometimes the menstrual cramps linked to heavy bleeding are so severe that you may be needed to seek medical attention.
Diagnosing Heavy Bleeding
When you visit your obstetrician-gynecologist about heavy bleeding, he/she may ask you about the things listed below:
- Pregnancy history
- Present and past surgical procedures and illnesses
- Medications, including over-the-counter medicines
- The method you use for birth control
- Your cycle
It is essential to track your menstrual cycle. This is because your gynecologist may want to know comprehensive information concerning several of your cycles. This may include the dates your menstruation began, the period the bleeding lasted, as well as the amount of menstrual flow (spotting heavy, medium, or light). To keep track of your menstrual cycle, you may use a period-tracking phone app or calendar.
Tests & Exams Used to Diagnose Heavy Bleeding
Your gynecologist will conduct a physical examination, which includes a pelvic exam. Several lab tests may also be done. Also, you may undergo tests for various STIs as well as a pregnancy test. Depending on your age and the symptoms you are experiencing, additional tests might be necessary as well. These tests may include the following:
Hysteroscopy- In this test, your ob-gyn inserts a thin, lighted scope in the uterus via the cervix opening. The scope allows the gynecologist to view the inside of your uterus.
Ultrasound examination- Sound waves create a photo of pelvic organs.
Magnetic resonance imaging- In the magnetic resonance imaging test, your gynecologist utilizes powerful magnets to generate images of various internal organs.
Endometrial biopsy- Here, an endometrium sample is extracted and observed using a microscope. In certain cases, your ob-gyn may use hysteroscopy to conduct this test. And in other cases, a surgical process known as dilation & curettage can also be used to perform this test.
Sonohysterography- Here, fluid is put in your uterus via the cervix using a narrow tube. Then, sound waves are used to generate images of the uterus lining. The fluid helps to show more details as compared to when only ultrasound is used.
Treating Heavy Bleeding
If irregular or heavy bleeding interferes with the quality of your life, you should visit a gynecologist as soon as possible. If your gynecologist determines that there aren’t any visible abnormalities, treatment may not be necessary. Heavy bleeding can be controlled by non-hormonal or hormonal treatment. Often, medications are first tested to treat heavy bleeding before they are released to the market. The following are ways of treating heavy bleeding.
- Certain heavy period problems can be managed with various hormonal birth control methods, for instance, heavy bleeding resulting from endometriosis, ovulation, fibroids, and polycystic ovary syndrome. Based on the birth control method, you use your menstrual flow can be lightened or your periods can be made more regular. In other cases, you may even stop experiencing menstrual blood completely.
- Gonadotropin-releasing hormone (GnRH) reduces fibroid size and stops your menstrual cycle. The hormones can be used only for a short period (less than six months). The effect of gonadotropin on fibroids isn’t permanent. Usually, when you stop using the medication, fibroids grow to their normal size.
- Hormone therapy may help treat heavy bleeding for women that are in their perimenopause stage. Before using hormone therapy, it’s crucial to weigh its risks and benefits. For instance, there is an increased risk of stroke, cancer, and heart attack.
- Non-steroidal anti-inflammatory medications like naproxen and ibuprofen may also help relieve menstrual cramps and treat heavy bleeding. These medications are more effective when combined with birth control pills.
- A prescription drug known as tranexamic acid can also treat heavy bleeding. The drug is in tablet form, and you take it every month at the beginning of your menstrual period.
- In case you have a bleeding disorder, treatment could include specific drugs that will help your blood to clot. Other treatment options include using hormone-containing IUD, which works well in other women.
Surgical Procedures Used to Treat Heavy Bleeding
In case medications do not reduce bleeding, your gynecologist may need you to undergo a surgical procedure. The procedures may include:
Endometrial ablation- Endometrial ablation is a procedure that destroys the uterus lining. It reduces or stops menstrual bleeding. After this procedure, you are not likely to get pregnant, but it may happen. In case you get pregnant, there is a significantly increased risk of severe complications. Also, after endometrial ablation, you will have to use a method of birth control until after you reach menopause. Sterilization, which is a permanent method of birth control, could be a better option to help prevent pregnancy in women who have undergone this procedure. You should only consider this procedure after drugs and other therapies haven’t worked.
Myomectomy- Myomectomy is a surgical procedure to get rid of fibroids without having to remove the uterus.
Uterine artery embolization (UAE)- UAE can also be used to cure fibroids. During this procedure, the blood vessels that go to the uterus are blocked. This stops blood flow that usually allows the growth of fibroids.
Hysteroscopy- Hysteroscopy is also another procedure done to get rid of fibroids or in other cases, stop the bleeding brought about by fibroids.
Hysterectomy- Hysterectomy refers to the surgical procedure to remove the uterus. This procedure treats adenomyosis and fibroids when other forms of treatment aren’t an option or have failed. Also, hysterectomy can be used to cure cancer of the uterus. Once the uterus has been removed, you will never get pregnant. Also, you will never have periods.
If you experience a heavy flow or a flow that goes beyond seven days, you have to rule out several things. One of these things is pregnancy. Also, using an in-office endometrial biopsy, your OBGYN can rule out any cancerous or precancerous source of bleeding.
Finally, in case the biopsy indicates you don’t have any cancerous source your OBGYN has to rule out an anatomical source of your bleeding. The source could be a fibroid or polyp. This is also the case if your uterus lining is responding well to hormonal stimulation. A polyp is different from a fibroid. Your gynecologist can expound more on the difference after your visit.
To determine whether you have a fibroid or a polyp, your OBGYN will carry out a specific in-office ultrasound. Sometimes, an MRI or CT scan might be necessary; they help to determine where the fibroids are located and their size. For certain women, an apparent reason for their heavy or irregular bleeding cannot be established. If this is the case, hormonal birth control in the form of birth control pills can help.
There are several treatment options for heavy bleeding, and sometimes one has to try more than one option before finding the right one. Which treatment is ideal for you is based on the cause of the heavy bleeding. Other factors like whether you want to preserve your fertility or uterus are also considered. At All Women’s Care, these procedures are done as same-day, outpatient surgeries. They do not require hospital stays or unsightly incisions. They also provide less painful and faster recovery compared to traditional surgery.
Consult a Gynecologist Near Me
Heavy bleeding during menstruation should not be overlooked. It could be an indication that you have a more severe health condition like uterine cancer. Similarly, heavy bleeding, if left unattended, may result in more severe complications like anemia. Therefore, we advise that if you believe your menstrual periods are excessive, consult a gynecologist immediately. For residents of Los Angeles, All Women’s Care is readily available to help. Our Los Angeles gynecologists will provide you with efficient, effective, friendly care. We will do our best to ensure your visit to our clinic is enjoyable and pleasant. Call us at 213-250-9461 for any questions, suggestions, consultation, and feedback on our services.