What are the causes of heavy menstrual bleeding?

Sometimes it may be related to an explainable problem with you, but sometimes there is no underlying problem.

There are some reasons that can cause excessive menstrual bleeding:

• One of your ovaries may not have produced eggs that month or for a long period of time.
• Benign tumors (fibroids)
• The presence of a bleeding disorder that prevents normal blood clotting
• Use of contraceptives and blood thinners
• Thyroid gland disorders
• Uterine cancer

How long is the duration of my period normal?

In a normal period, bleeding lasts less than 8 days. A complete filling of the pad or tampon every 1 to 2 hours or menstruation in large amounts are signs of heavy menstruation.

Is my bleeding an emergency?

If you completely contaminate more than 4 tampons or pads within 2 hours, you should see your doctor or go to the emergency room. If you are pregnant and bleeding, you should tell your doctor right away. Bleeding during pregnancy may be a sign of an emergency.

When should I see my doctor?

• If you are pregnant or think you may be pregnant,
• If your period lasts longer than 8 days
• If you completely fill the pad or tampon every 1 to 2 hours in each cycle
• If you need to use the pad and tampon together
• If you get up at night to change pads or tampons
• If you have clots that are larger than 5 cm in size
• If you bleed between periods
• If you menstruate more or less than once a month, menstrual irregularity
• If you have pain in the lower quadrants of your abdomen before or after menstruation
• If you have difficulty conceiving
• If you have not had a menstrual period for a year and thought you were going through menopause, but have had bleeding again after a year
• If you have any of the above symptoms and a low iron level. Signs of an iron deficiency include: Feeling weak and tired, headaches, difficulty breathing when active, and heartbeat that is faster than normal.

Are there any tests I should have done?

Your doctor will decide if you need any tests based on your age, symptoms, and individual situation. The following tests that doctors often request for women with excessive menstrual bleeding:

• Blood tests: They can help find out if you are pregnant, or if you have a hormone/clotting disorder, or if you have low iron levels, or if you have other problems.
• Endometrial biopsy: This test requires your doctor to take a sample from inside your uterus, which is then placed under a microscope in pathology to look for problems. This procedure can be done safely under local or general anesthesia.
• Pelvic ultrasound: a method that uses sound waves to visualize the uterus, ovaries, and vagina, and can also be used to monitor for fibroids or other pathologies.
• Hysteroscopy: During this examination, your doctor will use a small device to look inside your uterus.

How to treat heavy menstrual bleeding?

It depends on what is causing heavy menstrual bleeding and whether you want to get pregnant soon. You may not need treatment. If you do need treatment, here are some options:

• Hormonal contraceptives: you can reduce your periods or even stop them altogether. They may be given in the form of a pill, a patch on the skin, a ring inserted into the vagina, an injection every three months, or an IUD. The hormonal IUD is the best known of these methods.
• Medications that slow bleeding or thicken the blood.
• Pain medicines: Ibuprofen or mefenamic acid.
• Medicines that contain progestins, taken for a week every few months.

If you have fibroids and medications do not relieve your menstrual symptoms, your doctor may recommend surgery. Surgery options depend on your desire to become pregnant in the future.

• Removal of fibroids
• Endometrial ablation: burning the layer inside the uterus and turning it into scar tissue
• Uterine artery embolization: This is a procedure in which the vessels leading to the uterus are blocked (see my related article for detailed information)
• Hysterectomy: removal of the uterus. After this operation you will no longer have menstrual bleeding.