Menstrual periods are a normal part of a woman's life, but for one in five women, heavy periods can get in the way of a normal life. If you suffer from excessive menstrual bleeding, you may experience one or more of these symptoms that can disrupt your life and prevent you from keeping up with your normal routine:

* Periods that last longer than seven days

* Severe pain or cramping

* Flow that soaks through pads or tampons every hour for several consecutive hours

* Flow that includes large blood clots

* Heavy flow even while on birth control pills

* Exhaustion and fatigue during your period

What causes excessive menstrual bleeding?

Excessive menstrual bleeding has several causes, including:

Hormonal Imbalance

Estrogen and progesterone are the hormones that regulate the thickening of the endometrium, which is the lining of the uterus that is shed in each menstrual cycle. If the hormones are out of balance, the endometrium may become thicker than normal, resulting in a heavy period.

Fibroids

Fibroids are noncancerous growths in the uterus that can cause feelings of pressure and pain as well as heavy periods.

Polyps

Polyps are another form of fleshy growths on the uterine lining. In addition to heavy periods, they may cause bleeding between periods and bleeding after menopause.

Endometriosis

In this disease, the endometrial tissue that normally makes up the lining of the uterus is found outside of the uterus, sometimes on the ovaries, bladder, bowel or elsewhere in the lower abdomen. While some women with endometriosis have no symptoms, the disease can cause pain ranging from mild to severe, as well as infertility and heavy, painful periods.

Neoplasia

This condition is marked by the growth of new tissue and ranges from a simple thickening of the uterine lining to precancerous or cancerous growths.

Blood Clotting Disorders

Conditions such as von Willebrand's Disease prevent the blood from clotting properly, resulting in a heavier than normal flow.

Are certain age groups more prone to excessive menstrual bleeding?

Yes, it's more common in two age groups: young girls in the first year to year and a half of their menstrual cycles and women ages 35-49.

Can excessive menstrual bleeding prevent me from conceiving?

It depends on the cause. Some of the causes as well as some of the treatments can affect fertility.

What treatments are available?

Treatment options range from drug therapy to surgical procedures, depending on the cause for the condition.

Drug Therapy

Oral contraceptives are often effective, as they regulate the menstrual cycle and reduce excessive or prolonged bleeding. In addition, a progesterone containing IUD, such as Mirena, can offer medical relief without systemic hormones. For patients who also have anemia or low iron levels, an iron supplement may be recommended as well. Nonsteroidal anti-inflammatory drugs such as Advil or Motrin can also help reduce blood loss while relieving menstrual cramping.

Dilation & Curettage

In this procedure, often called a D&C, the cervix is dilated and the lining of the uterus is scraped with a spoon-shaped instrument. It is done on an outpatient basis and may be done with a local or minimal anesthetic.

Endometrial Ablation

This procedure destroys the uterine lining by using heat. Because an endometrial ablation may cause sterility, it's not an option for women who want to become pregnant in the future. Endometrial ablation can greatly reduce the menstrual flow or stop it altogether. This procedure can be done in the clinic with local anesthetic, or with minimal anesthesia as an outpatient surgery.

Hysterectomy

Removal of the uterus is definitive treatment for heavy menstrual bleeding. If you are not yet in menopause, your ovaries will be left in place so that your hormone function remains intact until your genetically programmed time to go through menopause. This is important to avoid possible symptoms associated with hormone loss. Hysterectomy is best performed two ways. The first is through the vagina, with no incisions on the abdomen. The second is through the laparoscope, where the surgery can likely be accomplished through one small incision in the belly button.

Talk to your OB/GYN

Some women who have excessive menstrual bleeding suffer in silence, thinking "That's just the way it is." Periods are a part of your normal life, but they don't need to disrupt it. You have too much going on in your life to be sidelined once a month. If excessive menstrual bleeding causes you pain, anxiety, and keeps you from your regular routine, talk to your OB/GYN and get the treatment you need to get back to your normal life, all month long. It is important for you to understand all of your options, so that you can decide for yourself which choice is the right one for you.



 
Dr. Shannon Bradley joined Mid Dakota Clinic in February 2001, as a specialist in obstetrics and gynecology.