Excessive Menstrual Bleeding: Quick Primer

WHAT IS IT?

An estimated one in five women bleed so heavily during their periods they have to put their lives on hold. The general term for this condition is "menorrhagia," meaning periods that are too heavy or that go on longer than the typical seven-day menstrual cycle. It is more common in women over 35 as hormonal levels shift during the transition to menopause. At this time of your life, you may have more menstrual cycles without ovulating (so your ovary doesn't release an egg). Without ovulation, your uterine lining builds up, leading to heavier than normal periods. However, heavy uterine bleeding can occur at any age. But remember, if you're past menopause and you aren't taking any hormones, ANY uterine bleeding you experience is considered abnormal and should be evaluated immediately by a health care professional.

SYMPTOMS

Symptoms of heavy menstrual bleeding include:

Menorrhagia is a major cause of iron-deficient anemia.

DIAGNOSIS

If you experience abnormally heavy bleeding during your period, your health care professional will run a series of tests. These may include:

TREATMENT

Excessive menstrual periods are very treatable. Options include medication, iron supplementation and minimally invasive surgery. Hysterectomy, while an option for ending menstrual bleeding, is no longer the only option and should not be considered without reviewing other options first with your health care professional. Treatment choices depend on your age, your desire to preserve your fertility and the cause of the bleeding.

Most health care professionals suggest beginning treatment with over-the-counter and prescription medications. These include:

• Oral contraceptives (OCs)—or birth control pills—are one of the most commonly prescribed medications for heavy menstrual bleeding, particularly if the bleeding is related to the absence of ovulation. They work by regulating hormonal levels, thus reducing the build-up of the uterine lining.

A newer option for women with heavy bleeding is endometrial ablation, a minimally invasive, outpatient surgical technique that destroys the lining of the uterus but leaves the uterus intact. Several different types of endometrial ablation can be used. They include:

Endometrial ablation is only offered as a treatment option to women who have finished childbearing. This is because, while it is possible to become pregnant after having endometrial ablation, potential risks to the mother's and the baby's health exist. Using a reliable form of contraception after having ablation is important. Overall, however, risks from endometrial ablation are low. Talk with your health care professional about which procedure is right for you.

While very effective in ending uterine bleeding (without a uterus, periods stop), hysterectomy is a major surgical procedure with a range of potential complications. Recovery can take between two and six weeks or longer, depending on the type of surgery performed. If your only medical problem is heavy bleeding, hysterectomy should be a last resort.

COMMONLY ASKED QUESTIONS

Question: When is heavy menstrual bleeding considered abnormal? Are my periods abnormal?

Answer: Abnormal uterine bleeding, also known as menorrhagia, is a menstrual period in which blood flow interferes with your normal activities. Most health care professionals will diagnose your period as "excessive" or "abnormal" if you bleed for more than seven days, and/or your bleeding is so severe that you go through a tampon and/or pad (or both) within an hour or less over several consecutive hours.

Question: Is there a certain age group of women who are more likely to have problems with heavy menstrual periods?

Answer: Yes. If you are between the ages of 40 and 50, you have a higher risk of excessive menstrual periods. This condition is more common as you get closer to menopause. But if you've just begun to menstruate, you may find similar problems with abnormally heavy periods. That's because young women who've just begun menstruating also have menstrual periods without ovulating more often than other age groups.

Question: Can heavy periods be a problem for me if I've already gone through menopause?

Answer: If you are post-menopausal and aren't taking any hormones, ANY uterine bleeding is considered abnormal and should be evaluated by a health care professional as soon as possible.

Question: What causes excessive menstrual bleeding?

Answer: There are numerous causes, including endometriosis, in which tissue that lines the uterus grows outside the uterus; fibroids (benign tumors in the uterus); blood clotting disorders; uterine cancer and pelvic infections. Hyperthyroidism (overproduction of thyroid hormone) or hypothyroidism (underproduction of thyroid hormone) can also result in heavy menstrual bleeding.

Most heavy menstrual bleeding, however, is related to hormonal abnormalities, usually because of menstrual cycles in which a woman doesn't release an egg from the ovary. Ovulation stimulates the production of progesterone, the hormone most important in keeping periods regular. Hormone imbalances can also be caused by a weight loss or gain of more than 15 pounds, heavy exercise, significant stress, illness or certain antianxiety and antipsychotic medicines.

Question: What are my treatment options for excessive menstrual bleeding?

Answer: Both medications and surgery are options. Typically, less invasive therapies such oral contraceptives and NSAIDs should be considered first. Ask your health care professional about the risk and benefits of all the options available to treat excessive menstrual bleeding, as well as the long-term success rates for each. Treatment choices depend on your age, your desire to preserve your fertility and the cause of the bleeding.

This information was produced with the assistance of an educational grant from Cytyc Corporation.