Menorrhagia: The Body Out of Balance

Most women will experience a heavy menstrual period at some point in her reproductive life. For some women, heavy periods are even the norm. “But if there is a change in heaviness get it evaluated,” says Dr. Carrie Ann Terrell, a specialist in women’s health. If you are soaking a pad or tampon within one to two hours for longer than one day, you should seek medical attention, she advises. It could be Menorrhagia, which the National Women’s Health Resource Center (NWHRC) defines as soaking a pad and/or tampon every hour or less during each menstrual cycle.

While Menorrhagia–which affects an estimated 10 to 20 percent of premenopausal women in the United States–can strike at any time, it is most likely to occur during puberty and the years just before menopause, when reproductive hormones are erratic.

“Women learn about periods, pregnancy and menopause but are unprepared for what happens in between. The fact is, pelvic health conditions can happen at any age, particularly after a woman’s had a baby,” explains Elizabeth Battaglino Cahill, RN, executive director of the NWHRC.

The condition can cause fatigue and anemia and restrict a woman’s personal and professional activities. Menorrhagia can also be indicative of more serious medical conditions.

According to the Mayo Foundation for Medical Education and Research, some common causes of Menorrhagia include: hormonal imbalance; uterine fibroids; polyps; dysfunction of the ovaries; adenomyosis; an intrauterine device malfunction; pregnancy complications; pelvic inflammatory disease, thyroid problems, endometriosis, and liver or kidney disease. In addition, certain drugs, including anti-inflammatory medications and anticoagulants (to prevent blood clots), can contribute to heavy or prolonged menstrual bleeding. In rare cases, uterine cancer, ovarian cancer and cervical cancer can cause excessive menstrual bleeding.

Ice packs, vitamin C, vitamin E and iron supplements can help reduce bleeding, but you should always check with your health care professional before taking any medication, even herbs and nutritional supplements, according to the NWHRC.

Medical treatment options for Menorrhagia continue to evolve.

“We think the sheer magnitude of how many Baby Boomer women are affected matters because such a large group will have the power to set new expectations for pelvic health, driving more women to seek treatment,” says Cahill. “Think back to when the default treatment for breast cancer was a total mastectomy. Those rates have dramatically declined primarily because women advocated for more minimally invasive treatment options. The same needs to be true for pelvic health.”

Currently, progestin–which works by reducing the effects of estrogen in your body, slowing growth of the uterine lining–is the most-prescribed medication for Menorrhagia, with studies finding that it can reduce bleeding up to 15 percent. However side effects, including weight gain, headaches, swelling and depression, lead many women to quit using this option.

Doctors may also prescribe nonsteroidal anti-inflammatory drugs such as Aleve, Motrin, Cataflam or Ponstel, which work by reducing levels of hormone-like chemicals that interfere with blood clotting. Studies find they can reduce blood flow an average of 25 to 35 percent. Oral contraceptives can also reduce menstrual bleeding up to 60 percent by preventing ovulation and thinning the endometrium.

Gonadotropin-releasing hormone agonists are drugs that are used only on a short-term basis because of their high cost and severe side effects. Basically, they temporarily send a woman into menopause, complete with hot flashes. However, they are very effective in reducing menstrual blood flow. But because they interfere with the activity of estrogen in your body, long-term use could lead to osteoporosis.

Doctors may also prescribe Danazol, is a form of the male hormone testosterone that blocks the action of estrogen in your body. It causes your period to stop in about four to six weeks, but can have side effects, including acne and reduced breast size.

Some physicians may also recommend using an intrauterine device such as Mirena, which releases a progestin called levonorgestrel, to help control the bleeding. The main side effect of this treatment can be some light bleeding between periods, particularly in the first three months.

Women with Menorrhagia may elect to have an outpatient procedure, endometrial ablation, in which the lining of the uterus is destroyed. In extremely severe cases, women with Menorrhagia may also opt for surgical procedures such as removal of the uterus through a hysterectomy. Other surgical procedures, including myomectomy and uterine artery embolization, may be used if fibroids are the cause behind the bleeding.

“Treatment for this condition is broadly available. What’s critical is that women and their health-care provider discuss menstruation as part of a routine physical exam,” says Amy Niles, President and CEO of NWHRC. “Beginning a dialogue about this vastly under-diagnosed condition and available treatment options– both between a woman and her doctor and among national health-care leaders– is the first step toward helping women live healthier more enjoyable lives.”

Questions to Ask Your Health Care Professional about Menorrhagia

1. Is the amount of menstrual bleeding I’m experiencing abnormal?

2. What tests do you need to conduct to diagnose my Menorrhagia, and why are you doing them?

3. Is this heavy bleeding affecting my iron levels? What can I do about that?

4. Why are you recommending this particular treatment option for my heavy bleeding? If that doesn’t work, what do you recommend next?

5. What are the disadvantages and risks associated with each recommended treatment?

6. Even if you find a problem like fibroids causing my abnormal uterine bleeding, is it possible to avoid a hysterectomy?

7. How many endometrial ablations of this type have you performed in the past year? What is your success rate? What kind of complications have you encountered?

– Source: National Women’s Health Resource Center

Originally published in Coastal Woman