Heavy menstrual periods (medically termed ‘menorrhagia’) are a common gynelogical concern, and a reason many women visit their doctors. Studies show that 10-35% of women report heavy menstrual periods. Though patients may not know the clinical definition of menorrhagia, I believe them when they report heavy periods symptoms. For some, a heavy period is classified by relative changes in flow compared to more “normal” cycles, or based on perceiving the flow to be “heavier than normal.”
Menorrhagia is clinically defined as menstrual flow lasting longer than seven days or greater than 80ml (5-6 tablespoons) blood flow. But who really knows how to measure blood flow that way? Admittedly, for both patients and physicians, blood loss is difficult to quantitate by these measures. More relevant descriptions of heavy menstrual flow may include:
- Soaking through a pad or tampon every 1-3 hours on your heaviest days
- “Doubling up” on pads or tampons to prevent soiling your clothing
- Needing to change pads at night to prevent soiling clothing, bedding
- Heavy flow, along with passing blood clots
- Iron-deficient anemia (low red blood cell count)
So why is the period so heavy? There’s not just one reason. Of the identifiable causes for heavy menstrual flow, reasons vary based on the particular age range of the patient. The most common causes include:
- Anovulation: irregular hormonal flow, resulting in abnormal menstrual flow (affects teens/menstruating women)
- Structural abnormalities: abnormal growths within the uterus, such as fibroids/polyps (more likely in menstruating/postmenopausal women)
- Bleeding abnormalities: conditions which affect our body’s bleeding/blood clotting system (rare, but usually diagnosed in teen years)
When evaluating you for heavy menstrual periods, your doctor may perform a pelvic exam, as well as order blood tests and a pelvic ultrasound. The blood tests are usually run to rule out anemia (low red blood cell count from heavy bleeding), a pregnancy test, and thyroid blood tests (occasionally thyroid disorders can contribute to menstrual changes.) A pelvic ultrasound is done to look for anatomic changes in your uterus (fibroids, polyps). Your doctor may also recommend an endometrial biopsy (a sampling of the tissue from the lining of the uterus).
In discussing treatment with patients, I usually focus on these four options.
1. Watchful waiting
Some changes in our flow are temporary, and over time correct themselves. As long as the symptoms are stable, and not worsening, a trial of watch-and-wait is an option.