• Introduction
• Excessive Menstrual Bleeding
• What are the Symptoms?
• Do I have excessive menstrual bleeding?
• What is Dysfunctional Uterine Bleeding (DUB)?
• Causes of Heavy Menstrual Bleeding
• Questions to Ask Your Doctor
• The Diagnosis of Heavy Menstrual Bleeding: 1. Blood Tests 2. Imaging Techniques 3. Hysteroscopy 4. Pelvic Examination 5. Medical and Personal History

Introduction:

More options than ever are available to treat excessive menstrual bleeding. For many women, the pain and inconvenience of heavy menstrual bleeding may interfere with living life to the fullest. If you're among them, the good news is there are treatment options. Where to start? You can begin by asking yourself a few simple questions.

Excessive Menstrual Bleeding:  When your period puts your life on hold because menstrual bleeding lasts to long or is too heavy it's time to ask your doctor a few important questions. Learn who's mostly to experience heavy menstural bleeding or menorrhagia, causes of excessive menstrual bleeding, diagnostic tests, and treatments for menorrhagia and get a list of questions to ask your health care provider about your heavy periods.

More options than ever are available to treat excessive menstrual bleeding. For many women, the pain and inconvenience of heavy menstrual bleeding may interfere with living life to the fullest. If you're among them, the good news is there are treatment options. Where to start? You can begin by asking yourself a few simple questions.

Menstruation is the shedding of the lining of the uterus (endometrium), and is a cycle that repeats itself approximately every 28 days in a woman who is not pregnant. Excessive menstrual bleeding, also known as menorrhagia, is defined as blood loss of more than 80mL during a menstrual cycle. This translates into bleeding for more than 7 days or using more than 10 pads or tampons per day during the menstrual cycle. Excessive menstrual bleeding is a common cause of iron-deficiency anemia.

What are the Symptoms?

Women describe the symptoms of excessive menstrual bleeding as unmanageable bleeding and a constant need to change soaked pads or tampons. They often complain of fatigue (a common side effect of anemia) and are concerned about embarrassing accidents.

Do I have excessive menstrual bleeding?

If you suffer from excessive menstrual bleeding, you're not alone. About 1 in 5 women have unusually heavy bleeding. You may be among them if you:

• Have periods that typically last seven days or more
• Have unmanageable bleeding or clotting
• Frequently need to change pads or tampons
• Bleed so heavily that you sometimes don't want to leave home
• If you've experienced any of these symptoms, you may have a condition known as excessive menstrual bleeding, medically called menorrhagia, a treatable condition that affects many women. There are options.
• If you've experienced any of these symptoms, you may have a condition known as excessive menstrual bleeding, medically called menorrhagia, a treatable condition that affects many women. There are options. 

What is Dysfunctional Uterine Bleeding (DUB)?

DUB is a common condition that affects approximately 1 out of 5 (22%) healthy, menstruating women. More than 10 million American women have this condition. It occurs because of a hormonal imbalance, and is distinct from other types of excessive menstrual bleeding because it is unrelated to fibroids, infection or disease. DUB commonly occurs in adolescents during the years following the onset of menstruation and results from a hormonal imbalance. It also occurs in women who are approaching menopause. DUB accounts for 20 percent of the 600,000 hysterectomies performed annually in the U.S.  

Causes of Heavy Menstrual Bleeding

• A hormonal imbalance during adolescence or menopause is the most common cause of heavy menstrual bleeding. Sponsored Links During adolescence after girls have their first periods, and for several years before the onset of menopause when menstruation ceases, our hormones levels are fluctuating which often leads to excessive uterine bleeding during our periods. It’s often possible to treat menorrhagia caused by hormonal imbalances with birth control pills or other hormones.
• Uterine fibroid tumors are another very common cause of excessive menstruation. It’s important to understand that fibroid tumors are usually benign (non-cancerous) tumors that often occur in the uterus of women during their thirties or forties. While the cause of uterine fibroid tumors is unclear, it is clear that they are estrogen-dependent. Several surgical treatments are available for treating fibroid tumors of the uterus including myomectomy, endometrial ablation, uterine artery embalization, and uterine balloon therapy, as well as hysterectomy. Non-surgical pharmacological treatments for fibroid tumors include GnRH agonists, oral contraceptives, androgens, RU486 (the abortion pill), and gestrinone. Some women find natural progesterone to be an effective treatment for uterine fibroid tumors. Often, when symptoms are not severe or troublesome, a “wait and see” approach is taken. Once menopause occurs, uterine fibroid tumors typically shrink and disappear without treatment.
• Cervical polyps are small, fragile growths that begin in either the mucosal surface of the cervix, or the endocervical canal and protrude through the opening of the cervix. The cause of cervical polyps is not clear; however, they are often the result of an infection and many times associated with an abnormal response to increased estrogen levels or congestion of the blood vessels located in the cervix. Women most commonly affected by cervical polyps are those over the age of twenty who have had children. A simple out patient office procedure that removes the growth, along with antibiotics, is the usual treatment for cervical polyps.
• Endometrial polyps are typically non-cancerous, growths that protrude from the lining of the uterus. The cause of endometrial polyps is unclear, although they are often associated with an excess of estrogen following hormone treatment or some types of ovarian tumors. Treatments for endometrial polyps include hysteroscopy and D&C.
• Lupus is a chronic inflammatory, and autoimmune disease that affects several parts of the body, particularly the skin, joints, blood, and kidneys. The cause of lupus is unclear; however, it’s believed that patients have a genetic predisposition to Lupus and scientists know that environmental factors such as infections, certain types of antibiotics -- particularly sulpha and penicillin drugs, UV light, severe stress, hormones and certain other drugs play a key role in triggering disease symptoms. The symptoms of Lupus vary widely among patients, as do the treatments which range from avoiding stress to drugs such as non-steroidal anti-inflammatory medications or NSAIDS, acetaminophen, steroids, antimalarials, cytoxic or immunosuppressive drugs, and anticoagulants
• Pelvic inflammatory disease (PID) is an infection of one or more organs that affects the uterus, fallopian tubes, and cervix. Sponsored Links PID is, most often, a sexually transmitted disease; however, it sometimes occurs following childbirth, abortion, or other gynecological procedures. The recommended treatment for pelvic inflammatory disease is antibiotic therapy
• Cervical cancer is a type of cancer that occurs when cells in the cervix become abnormal, multiply out of control, and damage healthy parts of the body. The human papillomavirus, or HPV, is the cause of over ninety percent of all cervical cancers. Treatments for cervical cancer include surgery, chemotherapy, and radiation therapy.
• Endometrial cancer occurs when abnormal cells in the uterus or the endometrium (the lining of the uterus) multiply out of control and damage to the uterus and other organs. While the cause of endometrial cancer is unknown, it is known that women diagnosed with this type of cancer tend are usually over fifty, often have endometrial hyperplasia, or many times use hormone replacement therapy (HRT). The first treatment for endometrial cancer is usually a hysterectomy, possibly followed by chemotherapy and/or radiation treatments.
• IUDs or intrauterine devices used for contraception are a potential cause of heavy menstrual bleeding or menorrhagia. Women who experience prolonged or heavy periods while using the IUD should have the device removed and choose an alternate method of birth control.
• Bleeding disorders occur when it is hard for a person to stop bleeding. While there are several types of bleeding disorders, the most common type in women is von Willebrand Disease or VWD. Treatments for von Willebrand Disease involve the release of stored clotting factors in the blood, or in extreme cases the replacement of the clotting factor with IV treatment or with prescribed nasal spray.

Questions to Ask Your Doctor

Excessive menstrual bleeding is an important health issue for women. At least one in five women bleed so heavily during their periods they have to put their normal lives on hold. The medical term for this condition is "menorrhagia," meaning periods that are too heavy or that go on longer than the typical seven-day menstrual cycle. It is more common in women over 35 as hormonal levels shift during the perimenopausal phase. However, heavy menstrual bleeding can occur at any age. Heavy menstrual bleeding is more than an inconvenience. It is also the most common cause of iron-related deficiency in women, and, if it's heavy enough, can even require hospitalization and blood transfusions.

If you experience heavy bleeding during your periods, your health care professional will conduct tests to rule out underlying problems like fibroids, uterine cancer, an infection, or endometriosis.

If you don't have any of these conditions, your bleeding is likely caused by hormonal imbalances. There are several treatments available for heavy menstrual bleeding, ranging from over-the-counter nonsteroidal anti-inflammatory medications, oral contraceptives and minimally invasive surgery that preserve the uterus, to hysterectomy, that removes the uterus.

Talk with your health care professional about heavy menstrual bleeding. Here is a list of questions to ask at your next office visit.

• Do you consider the amount of menstrual bleeding I'm experiencing abnormal?
• What tests do you need to conduct to diagnose symptoms, and why are you doing them?
• Is this heavy bleeding affecting my iron level? What can you do about that?
• Why are you recommending this particular treatment option for my heavy bleeding? If that doesn't work, what do you recommend next?
• What are the disadvantages and risks associated with each recommended treatment?
• Even if you find a problem like fibroids or endometriosis causing my abnormal uterine bleeding, is it possible to avoid a hysterectomy?
• Am I a candidate for endometrial ablation? What is the success rate for the technique you use? What kind of complications have you encountered?

The Diagnosis of Heavy Menstrual Bleeding:

It is often very difficult to diagnose true menorrhagia. For one, it is very difficult to measure blood loss during menstruation, and the perceptions of women as well as their physicians vary widely.

Some women may overestimate their menstrual flow. In one study 29% of women reporting menorrhagia had normal menstrual blood flow (less than about 2 oz, or 60 mL). In the study, such women tended to be anxious, unemployed, and also to have abdominal pain.

Some women underestimate it. For example, women with a family history of bleeding disorders might have menorrhagia but think it is normal because it is the same as their mother's or sister's.

Physicians may underestimate their patient's flow. In one study, comparing the perception of menstrual flow between physicians and patients, physicians believed that only 3.2% of their patients had menorrhagia while 53.7% of these patients self-reported the condition using an objective pictorial self-assessment chart.

• Blood Tests

Tests for bleeding disorders are important, particularly in very young women, before proceeding with invasive tests. Certainly blood testing for anemia is an important consideration in determining the need and type of treatment.

• Imaging Techniques

Ultrasound and Sonohysterography. Ultrasound is the standard imaging technique for evaluating the uterus and ovaries, detecting fibroids, ovarian cysts and tumors, and also obstructions in the urinary tract. It uses sound waves to produce an image of the organs and entails no risk and very little discomfort. Transvaginal sonohysterography uses ultrasound along with saline infused into the uterus, which enhances the visualization of the uterus. This technique is proving to be more accurate than standard ultrasound in identifying potential problems. Some experts believe it should become a first line diagnostic tool for diagnosing heavy bleeding. Magnetic Resonance Imaging. Magnetic resonance imaging (MRI) gives a better image of any fibroids that might be causing bleeding, but it is expensive and not usually necessary.

• Hysteroscopy

Hysteroscopy is a procedure that may be used to detect the presence of fibroids, polyps, or other causes of bleeding. (It may miss cases of uterine cancer, however, and is not a substitute for more invasive procedures, such as D&C or endometrial biopsy, if cancer is suspected.) It is done in the office setting and requires no incisions. The procedure uses a long flexible or rigid tube called a hysteroscope, which is inserted into the vagina and through the cervix to reach the uterus. A fiber optic light source and a tiny camera in the tube allow the physician to view the cavity. The uterus is filled with saline or carbon dioxide to inflate the cavity and provide better viewing. This generally causes cramping. Hysteroscopy is non-invasive, but 30% of women report severe pain with the procedure. The use of an anesthetic spray such as lidocaine may be highly effective in preventing pain from this procedure. Other complications include excessive fluid absorption, infection, and uterine perforation. Hysteroscopy is also employed as part of surgical procedures. [See Operative Hysteroscopy.]

• Pelvic Examination

A physician will perform a pelvic examination to check for pregnancy-related conditions and for signs of fibroids or other abnormalities, such as ovarian cysts.

• Medical and Personal History

The physician needs to have a complete history of any medical or personal conditions that might be causing heavy bleeding. He or she may need the following information:

1. Any family history of menstrual problems or bleeding disorders (which should be suspected in teenage girls with heavy bleeding). It should be noted that, in some cases, young women with heavy bleeding from inherited conditions may not even report it if they grew up in a family where such bleeding was considered normal.
2. The presence or history of any medical conditions that might be causing heavy bleeding.Women who visit their gynecologist with menstrual complaints, particularly heavy bleeding, pelvic pain, or both may actually have an underlying medical disorder, which must be ruled out.
3. The pattern of the menstrual bleeding. (If it occurs during regular menstruation, nonhormonal treatments are tried first.If it is irregular, occurs between periods, occurs after sex, is associated with pelvic pain, or if it occurs with premenstrual pain, the physician should look for specific conditions that may cause these problems.)
4. Regular use of any medications (including vitamins and over-the-counter agents).
5. Diet history, including caffeine and alcohol intake.
6. Past or present contraceptive use.
7. Any recent stressful events.
8. Sexual history. (It is very important that the patient trust the physician enough to describe any sexual activity that might be risky.)
9. Keeping a Menstrual Diary. The patient can provide much of this information by keeping a diary of the amount of bleeding and pain that occurs over the course of two or three menstrual cycles is very helpful. One method is to track menstrual flow day by day by observing the pad or tampon. It uses a score of 1 to 20 to signify very light staining to extremely heavy staining. The diary would also use a scale for pain of 0 to 4 (no pain to severe pain).