Heavy Menstrual Bleeding: What You Should Do About It

Heavy Menstrual Bleeding
Heavy menstrual bleeding is one of the most common problems women report to their doctors. It affects millions of women each year--Actually about one out of every five women has it.

Menstruation varies from person to person, making it harder to distinguish normal from excessive blood loss. So how do you tell if have heavy menstrual bleeding? If so, what are the consequences and what should you do about it?

Do you have Heavy Menstrual Bleeding?

Understanding whether or not you suffer from heavy menstrual bleeding requires the accurate recording of your menstrual history. The intensity of bleeding varies from person to person, so determining what is clinically heavy is tricky. Furthermore, while a single period can be heavy, a real problem isn’t likely to exist unless the heavy menstrual bleeding is present at least most of the time. The medical definition of this is when heavy menstrual bleeding is present for the majority of periods within the previous six months.

Possible Consequences of Heavy Menstrual Bleeding

Whenever you have a period, you lose blood. For those with normal bleeding, and a diet containing normal amounts of iron, blood loss, and iron intake should be in balance. However, for those with heavy menstrual bleeding, and especially when the diet is deficient in iron, blood loss can exceed iron intake and may result in an iron deficiency and possible low red blood count, or anemia. Iron deficiency, with or without anemia, can cause fatigue and interfere with the ability to concentrate exercise, and, enjoy life in general.

What should I do about it?

To treat heavy menstrual bleeding, you and your healthcare provider need to determine its cause or causes. This can be done by a few simple tests including a blood test, a transvaginal ultrasound and/or taking a sample of tissue from the uterine lining (endometrial biopsy).

Polyps: Surgical removal of the polyp is the most effective therapy.

Adenomyosis: Treatment with hormonal contraception, especially an intrauterine device that releases a hormone called progestin.

Fibroids: Some medical or hormonal therapies are effective, although procedures involving surgery are often necessary.

Cancer or pre-cancer: Most pre-cancers can be treated with medication, but cancers usually require surgery.

Blood clotting disorder: Tranexamic acid or hormonal medications are the usual treatment strategy.

Ovulatory disorders: Ovulatory disorders can generally be treated with hormonal medication such as progestins or other hormonal contraceptive medications.

Endometrial disorders: People with endometrial disorders can respond well to tranexamic acid, use of simple NSAIDs like ibuprofen, naproxen, or mefenamic acid, the progestin-releasing intrauterine system or other types of hormonal contraception. When a copper intrauterine device is a cause, some of the treatments for endometrial disorders can be effective.

Iron deficiency: Whenever there is an iron deficiency, and especially if there is anemia, an iron replacement should be part of the treatment.

Surgery can be important especially for the removal of polyps or fibroids since it can be performed simply and in a way that preserves fertility. Finally, invasive surgery (such as endometrial ablation and hysterectomy) is the last resort to help with the heavy menstrual bleeding but is always carefully considered as these procedures can remove your chances to bear children.

If you suspect you might have heavy menstrual bleeding, contact your healthcare provider immediately. This condition is easily treated in most cases. Early detection and diagnosis will make treatment more successful and less invasive.

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