What Can I Do About Heavy Menstrual Bleeding?

I always enjoy sharing these important issues with all of you.  It is so healing for us, as women, to realize that we do not suffer alone and that many others may share the same problems.  It is helpful to know that there is an answer or a way to get better.  If nothing else, these conversations bring understanding and validation.

Many of you are trying to deal with heavy cycles every month.  There are an estimated 10 million new cases of Heavy Menstrual Bleeding (HMB) in the United States every year!  So don't even think that you are alone. 

This has become such a problem, as it affects overall health and ability to just feel good and function at home and work.  It changes how women feel physically, and that affects emotions  - so their husbands and children are also impacted.  "Mom is always tired.  She doesn't act happy anymore and I think she is mad at me all the time."

For some women the bleeding comes only with your menstrual cycles, but it comes with such force and terrible cramping that it brings on nausea and vomiting - causing many of you to lose days from work every month.  Others of you just bleed heavily with little to no cramping, but the first 3 days of your cycle you don't dare leave the house and hope your work will be understanding AGAIN!

As women, we are used to having our cycles every month and actually are very sensitive to changes.  That's why things can get pretty horrible and out-of-control before some of you actually come in to seek help.  Our periods are like a fifth vital sign.  There's temperature, heart rate, blood pressure, respirations and, for women, our menstrual cycle.  Women come in all the time for 'emergency' appointments due to a missed cycle or because they had a double cycle.  The lucky ones have a one-time or occasional irregular cycle, immediately returning to normal.  Others of you are not so lucky and come in because the crazy, heavy cycle just got worse, and now you have been bleeding for 3 weeks straight (others even longer, like 3 months).

A THREE MONTH long period?  A three month long period with cramps and heavy, heavy bleeding with passage of strawberry- and cherry-sized blood clots?  Indeed.  The bleeding can get so strong that you use both tampons and pads, but the blood clots just push the tampons back out.  So off you go to sit on the toilet and let the clots and blood drip out, while you change your pad again for the 6^th or 8^th time that hour.   

This is 6-8 pads an hour for hours on end, with only a few hours of relief between bleeding episodes before it starts up again!  This can be how the first 2-3 days go.  It is no way to live, and over the past century treatment has come a long way.  Many women aren't interested in trying hormones or birth control pills, as they have tried them in the past without success.  Other forms of pharmacotherapy, which is what it is called, like non-steroidal anti-inflammatory drugs (such as Motrin, Advil and Aleve) or tranexamic acid are still considered first line treatment before a D & C or other forms of surgical treatment can be considered. Unfortunately, insurance companies make most of the medical decisions, and women have to "fail" hormone therapy before they can be approved for a surgical cure.  

Until the 1980s, the primary alternative to pharmacotherapy was a hysterectomy.  It is still a viable option and, for some, still the best decision.   Hysterectomy is a major operation, and if bleeding and pain are the only problem, endometrial ablation has become a preferred option.  So many women work and do not have the financial luxury of taking weeks off from work to recover.  The first ablations were attempted in 1930 with radio-frequency, but were not successful until 1981, when the Nd-Yag laser was used.  With endometrial ablation, a hysteroscopy can be performed beforehand to evaluate the inside of the uterus. Also, a D & C can be performed after the hysteroscopy (and before the ablation) so a tissue sample can be sent to pathology for evaluation and inspection.  Pictures are taken for documentation, which give the doctor and the patient an opportunity to go over the findings together.

The type of ablation performed is your choice.  Most will cause periods and the bleeding to go away, or at least return to a normal cycle.  Only 15% of women proceed to a hysterectomy after having an ablation, so this speaks for the success of the procedure. 

It’s important to note that excessive bleeding can also bring imbalance to the vaginal flora, so it is common to notice more vaginal odor and trouble with excess discharge.  I encourage all my patients to buy the WaterWorks system, as I have never found a better, natural, non-pharmacologic cure for these vaginal odor/discharge problems that are not due to infection.

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Normal Versus Abnormal Cycles

I am always baffled when I talk to my patients and realize how many do not understand their monthly cycles. How expectant we are as young women, knowing that any day 'the change' can come when the monthly cycles begin. Most of us begin them around age 12-14, and simply expect that they will come faithfully month after month until menopause. If they stop coming regularly, we become alarmed because that can be a sign of change in our overall health. However, most of us are not educated on what it means if our cycles become irregular.

Most woman will, on average, get her period for three to seven days once a month (really every 28 - 30 days). After menstruating for several years, women tend to settle into a cycle. Some women can even predict down to the day or hour when their periods will come. If you've been menstruating for a while, your body will get into a rhythm, which is why an irregular period is usually defined as any type of bleeding that's abnormal for you when compared to your last few menstrual cycles. It can include changes in the timing of your period or PMS, amount of bleeding, or different symptoms such as cramping, bloating, tender breasts or headaches.

The amount of blood per cycle varies from woman to woman, and can be much heavier in teens and those in peri menopause (the 5-10 years prior to menopause) due to erratic hormone fluctuations. A heavy period can cause the loss of up to 12 teaspoons of blood each month, while others may experience a period as light as four teaspoons. It may seem like a whole lot more than that, especially when we have a very heavy period with clots.

It is rare for periods to cause anemia, even with heavy monthly periods. Anemia from vaginal bleeding usually occurs when bleeding patterns change, causing prolonged cycles that last 20-30 days, with heavy bleeding and passage of clots. These can stop for a few days, and then the bleeding returns. The most common cause for this is hormone imbalance, organ dysfunction or anatomical abnormalities like uterine fibroids, polyps, infections, and ovarian cysts.

Every woman will experience an irregular period from time to time, and though, in most cases, they aren't dangerous, it's important to figure out what's causing the irregularity. Some of the more common reasons for abnormal menses are pregnancy, hormone imbalance from peri menopause, menopause, teen years, Polycystic Ovarian Syndrome (PCO), stress, and various medications. Another common reason for a late or missing period is the food you eat (and how it affects weight). Anorexia, extreme weight loss and low body fat can cause amenorrhea (loss of regular cycles). Women need a certain amount of body fat to have normal, regular cycles or to carry and grow a healthy baby. Likewise, extreme weight gain can cause hormone imbalance because excessive fat produces more estrogen. This can thicken the endometrial lining, causing heavy or irregular periods. Thyroid balance is extremely important for metabolism, weight control and regulation of periods.

If you were recently sick and had to take prescription or over-the-counter medication, your period may show up a day or two early or late and continue for several days, with bleeding/spotting. Some medications can interfere with the way your body metabolizes estrogen and progesterone which regulate menstrual cycles. Excessive drinking can also cause damage to the liver and may interfere with its ability to metabolize and regulate these hormones. This can be transient when drinking is only occasional, or can be permanent if alcoholism is involved.

Depending on the cause of your irregular period, there may or may not be much you can do about it. See your doctor about the symptoms you've been having and how irregular your periods have been. He or she can help you take the proper course of action. If you do not have access to this type of health care, then learn as much as you can about your body and how it functions so you can request a referral to a specialist so you can get the appropriate blood tests and ultrasounds.

Note, when periods become irregular and bleeding increases, it can create a pH imbalance in the vagina. This can cause a constant, frustrating battle with vaginal odor and discharge. That's why so many women are finding help with WaterWorks. WaterWorks is FDA-cleared for vaginal odor and discharge. It is all natural - using no chemicals, just plain water. It can be used every day for feminine hygiene to feel fresh and clean.

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