Are your menstrual periods too long, too fequent or are you bleeding too much?
The menstrual cycle is measured from the first day a woman starts bleeding with one menstrual period until the first day she starts bleeding with her next menstrual period. This is called the menstrual cycle length or menstrual cycle interval and is noramally 21 – 35 days long. The length of a woman’s menstrual period or menses is the number of days of bleeding and the normal range is between 2 – 7 days. Slight variations may be seen from month to month. If the menstrual cycle length is more than 7 days, then it is considered abnormal and called metrorrhagia.
If the volume of bleeding is too much, it is called menorrhagia. Typically, if a woman saturates more than 1 -2 pads or tampons per hour for several hours, it is considered too much bleeding. However, this definition can be a little vague. Some women change pads/tampons frequently through out the day regardless of the amount of bleeding. Perhaps the pads are not even close to saturation. Also, saturating a liner is much different than saturating a super absorbent tampon. It can be a little confusing. If a woman is completely saturating at least 1 -2 medium or large size pads or tampons in 1 hour or less time for several hours, it is likely too much bleeding. If a woman often has to wear double protection (ie. 1 pad and 1 tampons or 2 pads together) in order to prevent bleeding through to her clothing, it is likely too much bleeding. If a woman frequently has to stop doing her usual daily activities for 1 or more days during her menses due to excessive bleeding or fear of bleeding through to her clothes, it is likely too much bleeding.
If a woman’s menstrual blood flow is too heavy, to frequent, too long or a combination (called menometrorrhagia), over time, it can lead to anemia. Some syptoms of anemia include chronic fatigue, weakness, feeling short of breath (dyspnea), heart palpitations, chest pain, feeling dizzy, lightheaded or even passing out (loss of consciousness). Many different disorders may cause the menstrual bleeding cycle to be too long, too frequent, or too heavy. The list may include an imbalance in hormones, medications, blood clotting disorders, intrauterine or intracevical polyps, adenomyosis, endometriosis, benign fibroid tumors and sometimes even cancer. While this list is not exhaustive, it demonstates how different the sources of abnormal bleeding can be. It is important to have the bleeding evaluated in order to determine the correct diagnosis and treat with the most appropriate therapy as well as to rule out more serious causes like cancer.
If you have any of the above symptoms of too much menstrual bleeding, please contact your health care provider (HCP). Your HCP will likely need to take your history, review a list of all of your medications, do a physical and pelvic exam. Your HCP may order blood tests and imaging such as an ultrasound, CT (computerized tomography) or even an MRI (magnestic resonance imaging) of your pelvis. He or she may need to take a tissue sample from your uterus or cervix with an endoometrial or cervical biopsy. In some cases, your HCP may need to do outpatient surgery such as laparoscopy, hysteroscopy or D&C (dilation and curettage).
After diagnosing the source of your excessive menstrual bleeding, you and your HCP can discuss your treatment options. Some treatment options may include hormones which frequently can act as contraception as well. The list of hormonal options includes oral contraceptive pills (OCP’s), the contraceptive ring or patches, depot medroxyprogesterone injections every 3 months, the contraceptive subdermal rod, one of the progesterone containing IUD’s (intrauterine device) or even cycling on progesterone tablets. If you have polyps or fibroid tumors, they may be removed surgically. If you are finished with child bearing and no longer wish to become pregnant, you may consider an endometrial ablation or hysterectomy. This certainly not an exhaustive list of your options and every option is not appropriate for every patient. You will need to have a detailed discussion with your HCP to determine which option is best for you. So don’t delay; call your HCP to set up an appointment. Help is available for your excessive menstrual bleeding.
I am Scott A. Naegele, MD and I am a board-certified obstetrician and gynecologic surgeon who works at Thomas Hunter and Associates, PLLC in Charleston, WV. I work with two other physicians and a certified nurse practitioner. If you have further questions call us at (304) 343-4177 and set up an appointment. Any one of us will be happy to see you and answer any questions. You can also read about us on our webpage at www.charlestonwvobgyn.com or on our Facebook page at Thomas Hunter and Associates. Whether you chose to come see us or not, I urge you to see the HCP of your choice soon. You do not need to suffer every month.