Heavy menstrual bleeding is a term that can be applied to periods that consist of heavy bleeding or periods that, while not considered heavy, are longer than normal.
- Heavy bleeding is when there is blood loss of more than 80mL per month This is approximately 5 tablespoons or 16 soaked pads
- The average woman loses 30-45mL or 2-3 tablespoons of blood with each cycle
- Periods that last more than 7 days are considered prolonged
- The average period lasts 5 days
- In addition to the inconvenience and cost of changing pads frequently and ruining clothing heavy periods can cause anemia. Mild anemia, or low iron, commonly leads to fatigue and weakness but when anemia is severe can lead to hospitalizations and blood transfusions.
Structural causes of heavy bleeding include uterine polyps, adenomyosis, fibroids, and uterine cancer.
• Polyps are small, usually non-cancerous, growths along the lining of the uterus that bleed easily. They can be diagnosed and typically removed by hysteroscopy.
• Adenomyosis is a condition where the inner lining of the uterus starts to invade the muscle of the uterus. Patients with adenomyosis tend to have heavy and quite painful periods. An ultrasound or MRI can be used to help make the diagnosis. Symptoms can often be improved with contraception however the only definitive treatment is a hysterectomy.
• Fibroids are round, usually, non-cancerous growths made up of uterine muscle. They can push into the lining of the uterus, be contained within the wall of the uterus, or protrude from the uterus into the abdomen. An ultrasound is used to identify and measure fibroids. Treatment will depend on the location and size of the fibroids. Smaller fibroids can be observed without treatment or treated with medications. Larger, more symptomatic fibroids, can be removed hysteroscopically, laparoscopically, or by open surgery.
• Cancer is a rare cause of heavy periods but must be ruled out. An ultrasound can be done to evaluate the uterus and a biopsy can be done to sample the lining of the uterus.
Non-structural causes of heavy bleeding include bleeding disorders, ovulatory dysfunction, infections, and medications.
• Bleeding disorders are a common cause of abnormally heavy periods. Up to 20% of women with heavy periods have an underlying bleeding disorder. Blood work can be done to make a diagnosis. Bleeding disorders can frequently be treated with medications.
• Ovulatory dysfunction is another common cause of heavy periods. Without regular ovulation, menses become irregular which can lead to heavy bleeding. Your healthcare provider may ask you questions, do a physical exam, lab work or order an ultrasound to screen for ovulatory dysfunction. Menses can be regulated with medications such as contraception.
• Infections such as endometritis can irritate the lining of the uterus which can cause prolonged or heavy periods. A biopsy can be done to check for an infection that can be treated with antibiotics.
• Medications such as blood thinners and contraception can cause heavy periods. Lab work can be done to ensure the dose of a blood thinner is correct. If the bleeding is caused by contraception this may resolve with time or the type of contraception may need to be changed.