Heavy menstrual bleeding (known as Menorrhagia) is a common disorder in women. Heavy periods are common, about one third of women seek treatment for it, but it is not normal. It is difficult to define exactly what a heavy period is because it varies among women. Most women will lose less than 16 teaspoons of blood (80ml) during their period, with the average being around 6 to 8 teaspoons.
Most women have a good idea about how much bleeding is normal for them during their period and can tell when this changes. Heavy periods may be a sign of an underlying health problem that needs treatment. It can be caused by a number of conditions including problems with the uterus and hormones. Blood loss from heavy periods can lead to a condition called iron-deficiency anemia.
Your periods may be heavy if you:
Pain associated with menstruation is called dysmenorrhea. There are two types of dysmenorrhea, primary and secondary.
Primary dysmenorrhea is common menstrual cramps that are not due to disease. The pain usually begins 1 or 2 days before, or when menstrual bleeding starts, and is felt in the lower abdomen, back, or thighs. The pain can last for 1 to 3 days, and may be associated with nausea, vomiting, fatigue, and even diarrhea. It is usually caused by natural chemicals called prostaglandins that are made in the lining of the uterus. These cause the uterus to contract. As menstruation continues and the lining of the uterus is shed, the prostaglandin levels fall, and period pain decreases in severity.
Secondary dysmenorrhea is less common and is caused by a disorder in the reproductive system. This type of pain often lasts longer than normal menstrual cramps. It may begin a few days before a menstrual period starts. The pain may get worse as the menstrual period continues and may even persist after it ends.
The following conditions may cause either Heavy Period bleeding or Painful periods (or both).
Fibroids are non-cancerous growths that develop in or around the uterus.
Endometriosis is a condition where the tissue that lines the uterus (endometrium) is found outside the uterus, such as in the ovaries and fallopian tubes.
Adenomyosis is a condition where tissue from the uterus lining (endometrium) becomes implanted in the wall of the uterus.
Pelvic inflammatory disease (PID) is an infection in the upper genital tract (the uterus, fallopian tubes or ovaries). It can cause symptoms like pelvic or abdominal pain, bleeding after sex or between periods, vaginal discharge and fever.
An IUD (intrauterine contraceptive device) can make your periods heavier for the first 3 to 6 months after insertion.
The following conditions may also cause heavy bleeding.
If a woman does not ovulate regularly, areas of the lining of the uterus can become too thick. This condition is common during puberty and just before menopause. It also can occur in women with certain medical conditions, such as polycystic ovary syndrome (PCOS) and Hypothyroidism.
Heavy menstrual bleeding can be an early sign of endometrial cancer. Most cases of endometrial cancer are diagnosed in women in their mid 60s who are past menopause.
Blood thinners (such as aspirin, and other drugs) are taken to prevent blood clots. However, if the blood becomes too thin, there is an increased risk of bleeding, which may result in heavy menstrual bleed.
Blood Clotting Disorders
Persons who were born with conditions that prevent the blood from clotting properly (such as Von Willebrand Disease) are at risk of bleeding. Women with blood clotting disorders at risk for heavy menstrual bleed.
To determine the cause of heavy and/or painful periods, several tests may be done, some of which are mentioned below.
Pelvic Exam, Pregnancy Test, Blood Test, Urine Test
These may be done to identify Pelvic Inflammatory Disease, Pregnancy, Sexually Transmitted Infections, and other conditions.
This will allow any abnormalities in your reproductive organs to be detected, such as fibroids.
In this procedure, a thin, lighted scope is inserted into the vagina, through the cervix and into the uterus. It allows the inside of the uterus to be seen, and can identify abnormalities such as fibroids and polyps.
Endometrial Biopsy and Dilatation & Curettage
With Endometrial biopsy, a sample of the endometrium or lining of the uterus is removed and looked at under a microscope. A surgical procedure called dilation and curettage (D&C) is a similar test, where the lining of the uterus is scraped and then examined under the microscope. The endometrial tissue can then be examined for cancer or other abnormalities.
Laparoscopy is a surgical procedure, where small cuts are made in the abdomen through which a laparoscope is inserted. It can be used to look at the internal organs, as well as take samples of tissue for a biopsy. Laparoscopy is best for diagnosing Endometriosis.
Both heavy periods and painful periods can be treated with NSAIDS and Hormonal birth control methods.
Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, can help to control heavy bleeding and relieve menstrual cramps.
Hormonal Birth Control Methods
Birth control methods that contain estrogen and progestin, such as the pill, the patch, and the vaginal ring, can make periods more regular and reduce bleeding. They are also good at relieving severe period pain.
Heavy periods can also be treated using the methods below.
This is a prescription medication that treats heavy menstrual bleeding. It is a tablet that is taken each month at the start of the menstrual period.
Dilation and Curettage (D&C)
This procedure can be done to reduce menstrual bleeding by removing the top layer of the uterus lining.
This procedure involves removing all or part of the lining of the uterus. It destroys the lining of the uterus, and thereby reduces menstrual bleeding.
Myomectomy is surgery to remove fibroids without removing the uterus.
Hysterectomy is the surgical removal of the uterus. Hysterectomy is used to treat fibroids, Adenomyosis and endometrial cancer. After the uterus is removed, a woman can no longer get pregnant and will no longer have periods.
Staying active during your period may help to reduce pain. Try gentle exercises such as walking, cycling or swimming.
Heat and Massage
Putting a heat pad or hot water bottle (wrapped in a towel) on your abdomen may help reduce pain. Light, circular massage around your lower abdomen may also help to reduce pain.
Transcutaneous Electronic Nerve Stimulation (TENS) is a small battery-operated device that delivers a mild electrical current to your abdomen, which can help to reduce pain.
Vitamin B1 or magnesium supplements may help to reduce period pain and bloating. Acupuncture may also be helpful in relieving menstrual pain in some persons.
Hormonal Birth Control
If you are using hormonal birth control to relieve heavy bleeding or severe menstrual pain, remember to be consistent. These methods are less effective if they are not used correctly (or regularly).
Vaginal bleeding after menopause
Any woman, who has reached menopause, that has started having “period-like” vaginal bleeding again should see their doctor as soon as possible, to rule out endometrial cancer.
When choosing a surgical method to treat heavy periods, be mindful of those treatments that may prevent you from having children in the future, such as Endometrial ablation and Hysterectomy.
I hope these tips on HEAVY and PAINFUL periods were helpful; Remember, Your Health Is Invaluable!
By Dr. J. Lawarna Matthew
The American College of Obstetrician and Gynecology
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