Questions to Ask about Heavy Menstrual Bleeding

At one time or another, most women experience a menstrual period that seems much heavier or lasts longer than it normally does. If this persists for more than a few cycles, and you find yourself changing your tampon or pad every hour or two, you should consult your health care professional. Heavy menstrual bleeding can not only be inconvenient, it can lead to iron-deficient anemia and fatigue from excessive blood loss.

You may have a condition called "menorrhagia"—the medical term for excessive menstrual bleeding. A number of conditions can cause heavy menstrual bleeding, including fibroids, uterine cancer, pelvic infection, endometriosis, low or high thyroid hormone levels and clotting disorders.

The most common cause of heavy menstrual bleeding, however, is an imbalance of estrogen and progesterone—the hormones that control menstruation. Hormonal imbalances are common at puberty and during the transition to menopause. Extreme exercise, certain medications and weight loss or weight gain of more than 15 pounds also can cause hormonal imbalances.

Heavy menstrual periods aren't normal, but they are treatable. A range of treatment options may be considered to reduce or stop blood flow: medications that help to regulate hormonal fluctuations, minimally invasive surgeries such as uterine ablation that destroys the uterine lining or hysterectomy, in which the uterus is removed.

Your choice of treatment likely will depend on what's causing the heavy bleeding, how severe your symptoms are, your age, whether or not you wish to preserve your ability to have children and your personal medical history. Work with your health care professional to figure out what's right for you.

Here are some questions to help you start a discussion with your health care professional about excessive menstrual bleeding:

1. Why are my menstrual periods so heavy?
2. What tests will you perform to diagnose what's causing my heavy periods?
3. Is there anything I can do to make my periods lighter or lessen their effects on my daily life?
4. What over-the-counter and/or prescription medications would you recommend? What are their potential side effects?
5. I know that hysterectomy traditionally has been used to treat persistent menorrhagia, but that it is being replaced by newer, less invasive procedures. Do you ever still recommend hysterectomy, and if so, in what situations?
6. What are my other treatment options (endometrial ablation, endometrial resection, dilation and curettage), and what are their advantages and disadvantages?
7. If I want to preserve my ability to have children, what is my best option?
8. Are sexual side effects common with these treatments? What about other physical side effects, such as pain, urinary problems or menopausal symptoms?
9. What is the typical recovery time for each of these procedures?
10. Will the treatment you're recommending cure my heavy periods or will they come back after awhile?

For more information on heavy menstrual bleeding, visit "Fast Facts for Your Health: Heavy Menstrual Bleeding" and "Menstrual Disorders."