What's up with my bleeding?

Is my bleeding too heavy?

• Typical bleeding is
  • 3-7 days
  • Moderate flow (ie. 1 tampon or pad lasting more than 2 hours)
  • No or tiny blood clots
  • Bleeding tapers off after the first 2-3 days
  • Associated with mild to moderate cramping for the first 1-2 days
  • Woman feels normal during period
  • Woman able to perform all of her normal activities during her period
• Heavy bleeding is
  • 7-10 days
  • Heavy flow 1 or 2 days (ie. 1 tampon/hour on heaviest days)
  • Small to moderate blood clots (size of a quarter)
  • Bleeding tapers off after the first 4-5 days
  • Associated with moderate cramping on heaviest days
  • Woman feels drained during period
  • Woman plans her work or school activities around her period
• Pathologic bleeding is
  • 8 or more days
  • Heavy flow 3 or more days (soaks through pad and/or tampon in 1 hour or less)
  • Moderate to large clots (size of half dollar or larger)
  • Bleeding never fully tapers off
  • Associated with moderate to severe cramping
  • Woman feels weak, dizzy, exhausted during and after the period
  • Woman regularly misses work or school during her period
• Warning signs that your bleeding is more serious:
  • Bleeding between cycles
  • Bleeding during sexual intercourse
  • Flooding
  • Passing tissue
  • Sense of pelvic pressure
  • Malodorous discharge
  • Anemia associated with heavy periods/unexplained anemia
• What causes heavy periods?
  • Genetic factors
  • Female hormone imbalances like polycystic ovary syndrome
  • Infection of the uterus and/or cervix
  • Cancer of cervix
  • Cancer or pre-cancers (hyperplasia) of the uterus
  • Polyps of the uterine lining
  • Fibroids of the uterine lining or uterine wall
  • Adenomyosis of uterus where uterine glands infiltrate uterine muscle wall
  • Chronic anovulation where the lining is not completely shed each month
  • Thyroid disease
  • IUD usage
  • Abnormal blood clotting disorders like von Willebrand’s disease
• Which tests can help me to determine the cause of my heavy bleeding?
  • Pelvic exam
  • Cultures or microscope slide examination of discharge
  • Pelvic ultrasound—soundwave test of uterus
  • Pelvic CAT scan or MRI
  • Blood tests for hormones, thyroid problems, blood count and/or blood clotting factors
  • Sonohysterogram where sterile saline is placed into the uterus to outline the inner cavity
  • Biopsy of the lining of the uterus or cervix
  • Pap smear
  • Hysteroscopy—looking inside the uterus with a small lighted tube
• What treatments are available?
  • Depends on your age and desires for future fertility
  • I haven’t completed my family. Options:
    • Birth control pills
    • Mirena IUC—progesterone containing IUD
    • Cycle regulation with natural progesterone
    • Cycle regulation with synthetic progestins
    • IV or oral estrogen to stabilize the uterine lining
    • D &C with or without hysteroscopy
    • Treatment of underlying causes such as thyroid disease or clotting disorder
    • Removal of uterine fibroids
    • Removal of intrauterine polyps
  • I have completed my family. Options:
    • All of the above
    • Endometrial ablation—cauterizing the uterine lining
    • Hysterectomy—removal of the uterus