McFarland Clinic

Q&A with Dr. Jay Swanson: Heavy Periods

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May 3, 2011

Q: What causes a woman to have a heavy period (menorrhagia)?

A: Menorrhagia is an abnormally heavy and prolonged menstrual period at regular intervals.  This condition may be present due to many different causes.  The first step is to make sure that pregnancy is not the cause since a spontaneous miscarriage may be mistaken for a heavier than normal period. 
 
[Other] causes can be divided into anatomical and medical.  Heavy menstrual periods are most frequently caused by uterine fibroids or hormone imbalances. 
 
Hormone imbalances can cause the uterine lining to develop in excess and result in a heavy period when it sheds.  This is commonly caused by stressors in life, women just starting their menstrual cycle, or as a woman approaches menopause. 
 
Uterine fibroids are noncancerous growths of the muscle layer of the uterus that develop during the childbearing years. 
 
Other anatomical causes of menorrhagia include uterine polyps, ovarian cysts, ovary dysfunction, endometriosis, intrauterine device (IUD), adenomyosis, and certain types of cancer. 
 
Medical causes of menorrhagia include coagulation defects, thyroid disorders, chemotherapy, blood thinning medication, anti-inflammatory medication, pelvic inflammatory disease (PID), lupus, liver disease, kidney disease, and blood disorders.
 
 
Q: What symptoms should a woman be watching for that would indicate her period is heavier than “normal”?
 
A: To help women determine if their menstrual period is heavier than “normal,” she should ask herself the following questions: 
  • How often do you change your sanitary pad/tampon during peak flow days?
  • How many pads/tampons do you use over a single menstrual period?
  • Do you need to change the pad/tampon during the night?
  • How large are any clots that are passed?
  • Has a medical provider told you that you are anemic?
  • Does your menstrual period last more than 7 days? 
Women with a normal volume of menstrual bleed loss tend to:
  • Change pads/tampons at greater than 3-hour intervals
  • Use fewer than 21 pads/tampons per cycle
  • Seldom need to change the pad/tampon during the night
  • Have clots less than 1 inch in diameter
  • Not be anemic
  • Menstrual periods less than 7 days
 
 
Q: Can a heavy period indicate a serious health problem?
 
A: Yes, menorrhagia can be caused by an underlying medical condition as listed above.  Prolonged menorrhagia can lead to substantial blood loss, causing anemia.  Symptoms of anemia include feeling tired, shortness of breath, and a pale complexion.
 
 
Q: When should a woman see her doctor about her heavy period?
 
A: Women should seek medical assistance when their menstrual periods are starting to impact their quality of life.
 
 
Q: What treatment options are available to alleviate menorrhagia?
 
A: The treatment that you will receive depends on many factors, including the extent and cause of your condition.  If the degree of bleeding is mild, all that may be sought is reassurance from normal testing.  Also, iron supplementation and non-steroidal anti-inflammatory drugs (NSAIDs) are used for mild menorrhagia. 
 
For heavier menstrual bleeding, the condition is often treated with hormones or medication such as birth control pills, hormone progesterone (cyclic pills, Depo-Provera injections every 3 months, Implanon implantable progesterone every 3 years, or Mirena IUD every 5 years), or Tranexamic acid during the menstrual period. 
 
Surgery may be needed if drug therapy fails or if an underlying condition needs to be treated.  There are several surgical options available for the treatment of menorrhagia.  The procedure you may receive may depend on the type of underlying condition.  A dilation and curettage (D&C) is a minor surgery to temporary reduce bleeding for women still wanting to retain fertility. 
 
An operative hysteroscopy is used to view the uterine cavity [and] often used to remove a uterine polyp that may contribute to heavy menstrual bleeding. 
 
For women done with childbearing, a minor procedure called endometrial ablation (Novasure, Thermachoice) can scar the uterine lining, causing lighter or no menstrual periods after treatment. 
 
For patients wanting definitive treatment, a hysterectomy (removal of the uterus) can be performed and afterwards a woman will not have menstrual periods.  A hysterectomy is permanent and non-reversible, meaning a woman will not be able to become pregnant.  Newer techniques, such as laparoscopic hysterectomy, have reduced the recovery time to 2-4 weeks.   
 

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