Most
women occasionally experience heavy menstruation during their menstrual cycle;
for most women, heavy bleeding usually occurs during the final two to three
years before menopause or for the first few years after menstruation begins.
A good rule of thumb to help you
determine weather your bleeding is abnormal is... if you are soaking through
enough sanitary protection products to require changing more than every hour or
two or having a period which lasts over seven days... you are
probably experiencing heavy menstruation.
Some women are concerned by
clots in their menstruation, but clots--in most cases-- are a normal part of
your menstrual cycle. (The lining of the uterus is shed during menstruation and
any clots which you see are part of the uterine lining and, most often not cause
for alarm.)
What Causes Abnormal Uterine
Bleeding?
Menorrhagia (excessive uterine
bleeding) most commonly results from a hormonal imbalance in adolescents in the
years following onset of menstruation and in women who are approaching
menopause. Our periods tend to be irregular during these times and our ovaries
may or may not release an egg.
A common cause of abnormal
uterine bleeding is fibroid tumors; other causes of excessive bleeding which
your physician should consider include; cervical or endometrial polyps, lupus,
PID, as well as some more serious conditions including cervical or endometrial
cancer.
Women using intrauterine
devices(IUDs) for birth control, may also experience excessive or prolonged
periods; if you experience menorrhagia and you use an IUD, the IUD should be
removed and replaced with an alternative birth control method.
Usually detected soon after
menstruation begins, platelet disorders are the most common blood disorder which
causes excessive bleeding; the most common platelet disorder is von Willebrand's
disease. Women with von Willebrand's disease commonly will experience not only
heavy menstrual bleeding, but nosebleeds, easy bruising, and blood in the stool.
How is Diagnosis Made?
A pelvic exam is the first step
to determine the cause of menorrhagia, including a Pap smear and blood tests to
check for any underlying causes, as well as a pregnancy test when appropriate.
An ultrasound is often performed to check for any abnormalities, such as
fibroids and an endometrial biopsy, D &C, or hysteroscopy may also be performed
to further evaluate the condition of your uterus.
How is Excessive Bleeding
Treated?
Relief from menorrhagia is
achieved by treating the medical or physical (as in the case of an IUD) cause;
abnormal bleeding which does not appear to be related to another underlying
cause is often successfully treated with progesterone or a combination of
progesterone with estrogen, many times given in the form of an oral
contraceptive.
Women who experience menorrhagia
on a regular basis should be monitored closely for anemia and treatment with
iron supplementation may be necessary; many times, severe bleeding can be
treated with non steroidal anti-inflammatory drugs such as ibuprofen and
naproxen which sometimes help reduce the amount of blood as well as any
accompanying cramps.
Endometrial ablation once
commonly used to treat excessive bleeding in women past child bearing, who
wanted to avoid hysterectomy has now been replaced by a new therapy-- thermal
balloon ablation-- which in most cases ends bleeding by eliminating the lining
of the uterus. Only women no longer desiring to bear children are treated in
this manner as most women will be infertile following this
procedure, however this procedure is not a form of birth control and
another method of birth control must still be used to avoid pregnancy.
Women who are not pregnant and
who experience a single episode of heavy bleeding, usually require no medical
treatment-- getting plenty of rest-- often reduces the amount of blood flow, but
all women who experience heavy bleeding for over 24 hours should seek the
advice of their physician.
