If you’re experiencing heavy bleeding during periods, there can be many reasons for it. Luckily, most heavy menstrual bleeding is treatable. Learn what causes heavy periods and their treatment options in this article. Visit Doral Health and Wellness – Women’s Health Department and consult with the best Women’s health specialist in New York.
Causes and symptoms
In some cases, the reason for heavy menstrual bleeding is unknown. However, most of the time, the following conditions may cause heavy menstrual bleeding:
- Hormone imbalance: In a usual situation, during your menstrual cycle, you need a balance between the hormones estrogen and progesterone. These hormones control the thickening of the uterine lining. This lining is shed during a menstrual period. When hormones go out of balance, the lining becomes thicker and sheds, which causes heavy menstrual bleeding or unexpected bleeding between periods. Many conditions cause these hormonal imbalances, like obesity, insulin resistance, thyroid problems, and polycystic ovary syndrome.
- Problems with the ovaries: Sometimes ovaries don’t release an egg (this is called an ovulation) during a menstrual cycle. When this happens, your body doesn’t produce enough progesterone it needs during a menstrual cycle. It leads to hormone imbalance and may result in heavy menstrual bleeding or unexpected bleeding between periods.
- Uterine fibroids: These tumors develop during childbearing years and are mostly benign (non-cancerous) and may cause heavier than normal menstrual bleeding or bleeding that goes on for a long time.
- Polyps: These small growths occur in the uterus lining, which may cause heavy menstrual bleeding or periods to last longer. It may cause bleeding between periods. It also causes spotting or bleeding after menopause. Fortunately, they are not cancerous.
- Adenomyosis: This condition causes glands from the uterus lining to grow into the wall of the uterus itself, which leads to heavy bleeding and painful periods.
- Intrauterine device (IUD): Heavy menstrual bleeding is a common side effect of using a hormone-free IUD for birth control. So, make sure you talk to your doctor about other birth control options and choose IUDs with progestin that may ease heavy menstrual bleeding.
- Pregnancy complications: A single, heavy, late period can be due to miscarriage, or another cause of heavy bleeding during pregnancy can be due to the unusual location of the placenta, which supplies nutrition to the baby and removes waste. If the placenta is too low or covering the uterus’s opening (the cervix). This condition is also called the placenta previa.
- Cancer: Developing uterine cancer or cervical cancer can cause abnormal uterine bleeding and unexpected or heavy menstrual bleeding. These cancers can happen before or after menopause. Women who have had abnormal Pap tests in the past are at considerable risk of cervical cancer.
- Genetic bleeding disorders: Sometimes, bleeding disorders run in families that cause heavy menstrual bleeding. It includes von Willebrand’s disease, a condition in which blood doesn’t clot properly.
- Medicines: Some medicines can result in heavy or prolonged menstrual bleeding. It includes hormonal medicines like birth control pills or medicines that prevent blood clots like warfarin, enoxaparin, apixaban, and rivaroxaban.
- Other medical conditions: Many other medical conditions, like liver, kidney, and thyroid disease, cause heavy menstrual bleeding.
You may feel these symptoms of heavy menstrual bleeding:
- Soaking more than one sanitary pad or tampon every hour for several hours in a row.
- Needing double sanitary protection to manage menstrual flow.
- Getting up at night to change sanitary pads or tampons.
- Bleeding for more than a week.
- Passing blood clots.
- Limitations in your daily activities due to heavy menstrual flow.
- Feeling tired, fatigued, or short of breath due to blood loss.
Diagnosis and treatment of menorrhagia
To diagnose menorrhagia, your doctor will ask you about your health history and your periods. Then, they perform a physical exam, including a pelvic exam. Here, you may be asked to keep track of your periods and how many pads or tampons you use for a few months if you haven’t done so. After the physical exam, your doctor may recommend several tests to find the underlying cause of menorrhagia. It may include:
- Blood tests: A blood test is used to check for iron deficiency anemia. This sample of blood is also used to test for other conditions like thyroid disorders or blood clotting problems.
- Pap test: In this test, cells from the cervix are collected and sent to the lab for testing. These cells are tested for inflammation or changes that may be precancerous, which may lead to cancer. Cells are also tested for human papillomavirus (HPV) in women ages 25 to 30 and older.
- Endometrial biopsy: In this test, your doctor takes a tissue sample from the uterus and checks for signs of cancer or precancer of the uterus.
- Ultrasound: This imaging test uses sound waves to create pictures of your uterus, ovaries, and pelvis to check for abnormalities.
The results of these tests may lead to further testing, including:
- Sono hysterography: During this test, the doctor will inject the fluid through a tube into your uterus (through your vagina and cervix). Your doctor will use an ultrasound to get a clearer picture of the uterus to see the problem.
- Hysteroscopy: During this test, a thin, lighted instrument is inserted through the vagina and cervix into your uterus. This allows your doctor to see inside the uterus.
Heavy menstrual bleeding treatment is based on many factors, including:
- Your overall health and medical history.
- The cause of the condition and how serious it is.
- How well you manage certain medicines or procedures.
- Your plan to have children.
- How your condition affects your lifestyle.
- Your opinion or personal choices.
Treatment options include:
- Medications: Some medicines help to manage a heavy menstrual cycle, including:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): These include ibuprofen or naproxen sodium, which help lower menstrual blood loss. It also makes cramps less painful.
- Tranexamic acid: This also lowers menstrual blood loss. This needs to be taken at the time of bleeding.
- Oral contraceptives: Aside from birth control, they also regulate menstrual cycles and ease menstrual bleeding that is heavy or lasts a long time.
- Oral progesterone: This natural hormone, progesterone, can fix hormone imbalances and lower heavy menstrual bleeding. It is available in synthetic form as an oral medicine.
- Hormonal IUD (Mirena, Aletta, others): This intrauterine device produces a type of progestin called levonorgestrel, which makes the uterine lining thin and lowers menstrual blood flow and cramping.
- Other medicines: Gonadotropin-releasing hormone agonists and antagonists are called GnRH medicines. These medicines manage heavy uterine bleeding. Relugolix combined with estrogen and progestin can help to manage bleeding from fibroids. Elagolix with estrogen and progestin is used to treat fibroid-related bleeding. Elagolix alone even helps manage bleeding caused by endometriosis.
In case your heavy menstrual bleeding occurs from taking hormone medicine, you may need to stop or change it. If you have anemia due to heavy menstrual bleeding, you may need to take iron supplements. If your iron levels are low but you’re not anemic, you may not need iron supplements.
- Surgery:
If heavy menstrual bleeding doesn’t get better with medicines, then surgery is recommended. Treatment options include:
- Dilation and curettage: In this procedure, your doctor may open your cervix and then scrape or suction tissues from the uterus lining. Opening the cervix is called dilating, and suctioning tissues from the uterus lining is called curettage. This is also used to find the source of abnormal uterine bleeding. The cause of bleeding may involve polyps, fibroids, or cancer in the uterus. If you’ve had a miscarriage, you may need a D&C to empty your uterus. Hysteroscopy is also used with D&C to help the doctor find the source of bleeding in the uterus.
- Uterine artery embolization: This procedure is used to block blood flow to uterine fibroids. This blocking helps the fibroids shrink. During the procedure, the surgeon passes a catheter through the large artery in the thigh (known as the femoral artery). The surgeon then guides the catheter to the uterine blood vessels and injects tiny beads or sponges to lower blood flow in the fibroid.
- Focused ultrasound: This procedure is used to shrink fibroids by targeting and destroying them with ultrasound waves and radiofrequency energy. This needs no incisions.
- Myomectomy: This surgical procedure is used to remove uterine fibroids. Depending on the size, number, or location of the fibroids, your surgeon may perform this surgery with several small incisions in the abdomen. It is known as the laparoscopic approach. Or the surgeon may put a thin, flexible tube into the vagina and cervix to see and remove fibroids or polyps inside the uterus. This approach is called hysteroscopy.
- Endometrial ablation: This procedure is used to destroy the lining of the uterus. The process of destroying tissue is called ablation. The doctor uses a laser, radio waves, or heat on the lining of the uterus to destroy the tissue. After this procedure, you may have lighter periods. Pregnancy after this procedure is not safe. Use reliable or permanent birth control until menopause is recommended.
- Endometrial resection: In this procedure, the surgeon uses an electrosurgical wire loop to remove the uterine lining. Pregnancy isn’t safe after this procedure.
Sometimes heavy menstrual bleeding is a sign of another condition, like thyroid disease. In those cases, treating the condition can make your periods lighter.
When to go to your healthcare provider?
You need to contact your healthcare provider for heavy menstrual bleeding if:
- You have to change your pad or tampon every 1 or 2 hours.
- Bleeding lasts longer than 7 days.
- Have spotting or bleeding between periods.
- Pass clots that are the size of a quarter or larger.
Heavy periods can occur for many reasons. But they are treatable. Just notice heavy periods of symptoms to get a timely diagnosis and treatment to manage your condition.
Need help with heavy periods? Visit our Women’s Health department in Brooklyn to get professional medical help. Call us to book your appointment now!!!!!!
Log on to www.doralhw.org or visit us at 1797 Pitkin Avenue, Brooklyn, NY 11212 to book an appointment. At Doral Health and Wellness – Women’s Health Center, we have the best GYN doctor in Brooklyn, and we provide women with quality health care services. You can also visit our website at https://doralhw.org/department/gynecology/
