Part One – Background, Definition, Causes
By: Jean Johnson for Uterus1
Heavy bleeding or menorrhagia is the most common gynecologic complaint that sends women in to see professionals. This troublesome symptom is also the cause of two-thirds of the hysterectomies that are performed in the United States each year. Although one in every three women sees a physician for menorrhagia, only one in 10 has actual clinical symptoms. That said, there are women who have heavy bleeding but for various reasons – that might include family history, high tolerance for discomfort, or general disinclination to consult health care providers – do not address the problem at all.
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“The thing is,” said Heather Landtole of San Francisco who formerly had periods marked by such heavy bleeding that she was housebound for several days each month. “We don’t have to put up with this problem like our mothers and grandmothers did. Gone are the days when women need to suffer in silent embarrassment. It’s a new millennium ladies, so get to your physicians! They are there to provide a service to you. That’s how we need to think about it, not like female problems are some dark, secret humiliation. I know once I got over that hurdle and got help – I confess that it did help to have a female gynecologist – my life changed I’m much more confident than I was before when I had to worry all the time and felt such shame about possibly staining my clothing and the sheets.”
Periods that range beyond three to seven days with blood loss greater than 80 milliliters (16 teaspoons) are considered heavy. Normal periods range from 20 to 60 ml. with flow such that pads do not need to be changed more than every two hours at the most.
Although passing clots are normal, often there are also larger than normal blood clots associated with menorrhagia. Also, flooding which is bleeding through clothes or onto bedding at night, is generally present. Anemia is another symptom of excessive bleeding, and women in whom red blood cell counts are low can experience fatigue, dizziness and develop pale skin.
Generally most women have occasional heavy bleeding at some point in their reproductive cycle. But menorrhagia is typically associated with the last two or three years before menopause as well as the first few years of menstruation. The good news is that those who go through natural menopause later in life between the ages of 50 and 54 are more likely to live longer than their peers who stop menstruating early in their 40s. Then again, the two million women each year who have heavy bleeding so severe that they consult their physicians might not equate a prolonged menstrual cycle with too much immediate happiness.
Age and menorrhagia
Heaving bleeding is more common in women who are not ovulating; thus it is commonly seen in patients at either the beginning or end of their reproductive cycle. Women approaching menopause may have erratic cycles with the times in between periods shorter or longer than normal. They might also experience especially heavy bleeding that lasts well beyond a full week, even as long as two and three weeks. This pattern affects women over 45 and is associated with changing hormonal balances.
Younger women may also have irregular cycles with several months elapsing between periods. Then when their period does come it can be marked by excessively heaving bleeding which results from the body finally expelling the accumulated blood in the uterine lining. This can be accompanied by significant pain and cramping.
After Lori Rice of Pittsburgh starting menstruating at age 10, she grew to fear her monthly cycles. “I was having a lot of problems with my period – cramping and heavy bleeding,” said Rice. “The pain was the worst. I missed a lot of school, and it got worse the longer I had my period.”
Causes of heavy bleeding
Although menorrhagia is most often not due to an underlying medical problem and is associated with changes in hormones that regulate the menstrual cycle, a number of underlying causes have been associated with heavy bleeding.
The female reproductive organs are relatively simple in design – the upside down pear-shaped uterus with its two slender fallopian tubes flaring out from the top and an ovary nestled at the end of each one; a thick stalk marked by the cervix and vagina supporting the whole works. Menstruation occurs when the lining of the uterus thickens in preparation for pregnancy. When no egg is fertilized, the body sheds this blood-rich lining.
Consequently, any infection in the vagina, cervix, uterus or fallopian tubes can interfere with the normal working of the female reproductive system and cause heavy bleeding during menstrual cycles. These types of infections are often lumped together under the rubric of pelvic inflammatory disease (PID). While PID is most often a sexually transmitted disease, infections can also follow childbirth, abortion and a range of gynecological procedures. (In essence, anything that breeches the body’s sterile confines is capable of causing infection.)
Fibroids, benign lumps in the muscle wall of the uterus, can also cause heavy bleeding that can include flooding (or gushing when a women stands up or changes position). Fibroid masses are quite common in women in their thirties and forties, although most do not reach sizes that cause symptoms including menorrhagia.
Additionally, heavy flows can result from intra-uterine devices (IUD) or coils that are inserted into the uterus by physicians to prevent pregnancy. “I had an IUD for over 10 years in my twenties,” said Roberta Lincoln of Phoenix. “I guess my periods were what you might call heavy bleeding. Certainly my flows were more substantial than before I got the IUD. But back then I was willing to put up with it in order to not get pregnant. My husband and I wanted to wait until we were older, and I liked not having to mess with the whole birth control pill thing. But on the bleeding, I guess there were only a couple days each month when I’d soak through pads pretty fast and had to put the bed sheets through the laundry quite a bit. Beyond that, it was more the time factor that bothered me. My periods seemed to go on forever. Or they’d get spotty and I’d think I was about done, only to have it start back up again especially if we had sex. I guess since I didn’t have any pain and also managed to keep up with my classes and work and our social life, I just went with it. It was more of a nuisance that anything.”
A range of more complex medical conditions can also produce menorrhagia, and prudent women who experience persistent heavy bleeding do tend to consult their healthcare providers. Polyps on the cervix or uterus, also benign growths like fibroids, can cause heavy bleeding and are related to high estrogen levels. Lupus, a type of chronic arthritis and autoimmune disease, can also be a factor, as can be the bleeding disorder known as Von Willebrand Disease which affects clotting. Finally, cancers associated with the female reproductive organs, in particular the cervix and uterus, can manifest in a number of symptoms including menorrhagia.
In other words, although the female reproductive system appears as a deceptively simple flower, its function is exceedingly complex, as is its malfunction. So, women who suspect they have menorrhagia – as defined by blood loss greater than 80 ml. and duration of more than seven days – might want to follow Landtole’s approach.
“I kept a record of how many pads I used and the number of days my period lasted for a couple months before I went in. That way my gynecologist had something more precise to go on than my general complaints,” she said. “It worked. She figured out what my problem was and began treating it. My body responded right away, and my life has been so much better since then. I can’t believe I put off going in like I did.”
In Part Two, diagnosis and treatment of heavy bleeding will be discussed. So if you’re suffering or know someone who is, come along to see how both Heather Landtole and Lori Rice got help. Also, learn how physicians diagnose heavy bleeding and how they treat the problem once they’ve figured out its cause.
If you enjoyed this article, you might also be interested in the following:
Surgery and IUD Produce Similar Patient Results for Heavy Periods
IUD Device Doubles as Treatment for Heavy Periods
Women With Heavy Periods Express Concern About Symptoms, Treatment Options
Less Invasive Treatment for Excessive Uterine Bleeding