How do you know when your period is normal and when it’s not? Menstrual bleeding is different for every woman and can change as you age. There might be days when you have a heavy flow and cramps, which is completely normal. But if you have heavy bleeding that interferes with daily activities, you could have a condition called menorrhagia, or heavy menstrual bleeding.
Heavy menstrual bleeding can be caused by subtle health problems that can go unnoticed. In some cases, a larger health issue is the problem. For instance, endometriosis can cause painful and heavy periods. March is Endometriosis Awareness Month, so now is a good time to get familiar with its symptoms.
If you experience heavy menstrual bleeding, it might be time to talk to your doctor. Your doctor will ask you about your health history, perform a physical exam and may order tests like an ultrasound, Pap test or blood tests. After your doctor rules out other potential health problems, they may be able to diagnose you with menorrhagia.
Signs and symptoms of menorrhagia may include:
- Soaking through one or more sanitary pads or tampons every hour for several hours
- Waking up in the middle of the night to change their sanitary pads
- Using two sanitary pads to manage heavy menstrual bleeding
- Bleeding longer than a week
- Passing blood clots larger than a quarter
- Restricting daily activities due to heavy menstrual bleeding
- Symptoms of anemia, tiredness, fatigue, and shortness of breath
Possible Causes
While heavy menstrual bleeding should make you stop and think, there are many reasons why some women have periodic heavy bleeding. Changes in age, approaching menopause and certain types of birth control can all trigger abnormal menstrual cycles.
A menstrual cycle occurs when hormones, like estrogen and progesterone, prepare a woman’s body for a possible pregnancy by thickening uterine lining, called the endometrium. If the egg isn’t fertilized, hormone levels decrease and the body sheds the endometrium, producing the menstrual cycle.
Heavy menstrual bleeding can occur if any part of your menstrual cycle is disrupted. This could be related to a hormone imbalance, abnormal growths in your reproductive organs or stress. Below is a list of general causes that can be explored with your doctor.
1. Hormone-related problems: Hormone imbalance can cause your body to make the lining too thick, which leads to heavy menstrual bleeding.
2. Uterine-related problems:
- Female cancers are rare but can affect your reproductive organs. Your doctor may take a tissue sampling of your uterine lining to test for abnormal cells to be safe.
- Endometriosis is a condition that causes tissues in the uterine wall to grow outside of itself causing severe pain, cramping, and heavy menstrual bleeding.
- Endometrial polyps are a common abnormality and are usually benign. Endometrial polyps growing in the wrong place can be treated safely hysteroscopic excision.
- Fibroids are common for a lot of women. According to the Office on Women’s Health, anywhere from 20% to 80% of women have fibroids at some point by age 50. You may have had them and not even noticed because they don’t cause pain or symptoms. Fibroids can lead to heavy bleeding if they grow in places they shouldn’t or grow too big.
- Problems related to pregnancy, such as miscarriage or ectopic pregnancy can cause heavy menstrual bleeding.
3. Other illnesses or disorders:
- Bleeding disorders, such as von Willebrand disease (WWD) are not common, but if the disorder runs in your family, you could be at risk.
- Nonbleeding-related disorders such as liver or kidney disease can disrupt your flow.
- Thyroid problems can cause abnormal production of hormones. Most thyroid problems can be managed if properly diagnosed and treated.
- Pelvic inflammatory disease (PID) is a sexually transmitted infection like chlamydia or gonorrhea that can disrupt your menstrual cycle. PID can be treated with antibiotics.
4. Medications and lifestyle:
- Medications like blood thinners and anti-inflammatories can cause heavy periods.
- Lifestyle factors like fluctuations in weight and high levels of stress may contribute to heavy bleeding.
Treatment Options
Your doctor can determine the cause of heavy menstrual bleeding with blood work. They may also take tissue sampling of the uterine lining to screen for abnormal cells. Other tests can include an ultrasound or an x-ray of your uterus.
Depending on the results from your tests, your doctor might prescribe hormones such as birth control and IUDs, NSAIDs for pain, or a non-hormonal drug called tranexamic acid. Surgical procedures are a possibility for certain causes. Although, surgery should be carefully considered as they could result in the inability to have children or make pregnancy unlikely and risky.
Overall, the types of treatment and tests will largely depend on your situation, general health, and medical history. Talk to your doctor to find the best fit for you.
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At Green Valley OB/GYN we strive to provide comprehensive care for our patients so that they have the healthiest and safest pregnancy possible. If you have questions or concerns about your pregnancy health, including exercising during pregnancy, call our Greensboro office at (336) 378-1110 to make an appointment.