The inside lining of the uterus is the endometrium. The endometrium proliferates by building up and continuing to thicken until menstruation begins. During menstruation, the endometrial lining sheds.
Menstruation is usually from two to ten days. The first day most women experience light spotting or light flow. The second and third days are usually heavier, and then the flow generally tapers off until it stops entirely.
Menstruation for some women occurs every twenty-eight days like clockwork, with a similar amount of bleeding every month and a regular, predictable cycle. For other women it varies considerably from month to month, with some cycles heavier or lighter than others and a less predictable cycle.
Normal changes in menstruation occur gradually over time. The menstrual cycle and flow of a teenager is different when she is in her 20’s than it is when she is in her 30’s and 40’s.
Variations in menstruation are often familial, what is common among the women in your family. Some variables in the length of the cycle and the amount of bleeding may be influenced by diet, exercise, stress, travel, environmental factors, weight loss/gain, or illness
If a panty liner is usually all that is needed during menstruation and then you unexpectedly need to use two super pads and a super tampon, that is a significant departure from the amount of bleeding that is normal for you. If bleeding becomes so heavy that it is unmanageable, or if you are unable to work or leave home during menstruation because of the heavy flow, you may want to ask a family doctor or gynecologist for a written order to get a pelvic and transvaginal ultrasound to evaluate the pelvis. Heavy menstrual bleeding with large blood clots, which is most often caused by submucosal fibroids, can be diagnosed with an ultrasound.
The ultrasound should be performed in the Radiology Department of a good hospital, not in a gynecologist’s office. When an ultrasound is done in a doctor’s office you do not have the benefit of a radiologist to evaluate their findings and give you a detailed written report of the findings.
When you receive the written order for an ultrasound, tell the receptionist in the office of the doctor who gave you the written order to email, fax, or mail the results to you when they receive the report. Then call the best hospital near you and ask for the Radiology Department. Tell them you have a written order for a pelvic and transvaginal ultrasound to evaluate the pelvis, and they will schedule an appointment for you.
The medical term for heavy or excessive bleeding at regular intervals is menorrhagia (men-or-raja). Menorrhagia occurs when the time between menstrual cycles remains fairly consistent, but bleeding is heavier than usual.
Menometarorrhagia (men-o-met-ah-raja) is the medical term for irregular excessive bleeding or continuous bleeding. Menometarorrhagia can be caused by stress, illness, travel, or climate change. It is most commonly caused by endometrial hyperplasia, polyps, thyroid imbalance, Von Willebrand’s, and adenomyosis.
An effective way to diagnose endometrial hyperplasia is with a pelvic and transvaginal ultrasound performed in the Radiology Department of a hospital or a free-standing imaging center, not in a gynecologist’s office. For more information about hyperplasia, click here.
A cervical or endocervical polyp is a mass of tissue growing from the cervix at the end of a stalk or stem. More than 99% of all polyps are benign. They often do not cause symptoms, but they may cause bleeding or spotting with intercourse or manual stimulation of the cervix. The most effective and least invasive way to remove polyps is with a polypectomy. For more information about polyps, click here.
A blood test that includes a thyroid stimulating hormone test should be done to test for a thyroid or pituitary imbalance that may be the cause of menometarorrhagia. See below.
Von Willebrand’s Disease is a hereditary, treatable blood disorder that affects the blood’s ability to clot. It can be diagnosed with a blood test, and is most often treated by a hematologist.
The only objective and non-invasive way of diagnosing adenomyosis is with an MRI- magnetic resonance imaging- of the pelvis, not a laparoscopy. For more information about adenomyosis, click here.
Uterine fibroids that cause very heavy menstrual bleeding with large bloods are submucosal. “Submucosal” refers to fibroids located in the inside layer of the uterus, the endometrium. For more information about fibroids, click here.
Women who experience heavy or excessive menstrual periods may be concerned that they are anemic. Although it may seem like a lot of blood, heavy menstrual flow does not usually cause anemia. If you are concerned, ask to have a blood test done during the period of time that you are experiencing heavy bleeding. At most, you may have to find you have a borderline, low, transient anemia that returns to normal when the heavy menstrual flow stops.
Anemia can become an issue if true hemorrhaging occurs. If bleeding soaks through two super pads with one or two super tampons within 20-30 minutes, the blood loss is significant and you may be hemorrhaging. Let your doctor know if you experience this type of bleeding.
If you stand up after sitting or reclining, you may have a sudden gushing of blood. This is usually just gravity taking over when blood that has collected at the opening of the uterus or in the vagina suddenly flows out because you are standing.
A complete blood count (CBC) will measure the level of red blood cells, white blood cells, and platelets in a sample of your blood. It will show if you are anemic. A blood test should also be done to test for a thyroid or pituitary imbalance that may be the cause of menometarorrhagia.
When a CBC is done for unusually heavy menstrual bleeding it should include a thyroid stimulating hormone test (TSH, also called a thyrotropin test). The TSH will determine if you have hypothyroidism (an underactive thyroid) or hyperthyroidism (an overactive thyroid). Even a slightly low or slightly elevated TSH can play havoc with menstruation. Often, only a very small dosage of thyroid medication is needed to resolve excessive menstrual bleeding.
If you are anemic, your hemoglobin, hematocrit, and iron levels will be low. Hemoglobin, HGC, refers to the protein molecules that carry oxygen from the lungs to the body’s tissues and returns carbon dioxide from the tissues to the lungs. Hematocrit, HCT, refers to the proportion of red blood cells by volume in the blood. Slightly low or borderline HGB levels of 10-12 and/or an HCT of 32-34 are not a cause for concern. These levels usually return to normal when heavy bleeding diminishes.
Excessive bleeding may be slowed by lying on your back with your feet slightly elevated and an ice pack on your pelvis.Although a heating pad may feel better than an ice pack, heat increases blood flow while cold decreases it. If you get a cut you apply ice or hold it under cold water to slow the blood flow. The same principle applies to heavy uterine bleeding.
Do not take aspirin just before or during menstruation. Aspirin increases bleeding.
If your HGB is low, you can usually bring your blood count back to normal within 48 hours by eating liver. No other source of iron in food or supplements is as effective as liver. The liver should be broiled or pan-fried.
If your HGB is 8-10, eating liver once or twice a week is often sufficient to bring your blood count up to normal. If your HGB is 6-8, eating liver four or five days a week may bring your hemoglobin up. If your HGB is lower than 6, eat liver every day. Eating liver will not solve the cause of the anemia, but it will keep your blood count up until the problem causing the anemia can be diagnosed and resolved.
Some people like liver, others abhor it. If you do not like liver, one way to make it more palatable is to get chopped liver from a delicatessen and add soy sauce, which is how it is frequently served in Japan. If you will not consider eating liver, foods that are rich in iron include: dark leafy vegetables (especially spinach and collard greens), red meat, egg yolks, dried fruit (especially prunes and raisins), iron-enriched cereals and grains, some sea foods (oysters, clams, scallops), turkey or chicken giblets, beans, lentils, chick peas, soybeans, and artichokes. However, because you would need to consume large amounts of these foods to bring your HGB, HCT, and iron up to levels that are approaching normal, they are not nearly as effective at improving anemia as liver.
Acupuncture can be effective for relief of excessive menstrual bleeding, particularly if it is caused by a hormone or endocrine imbalance. Black cohosh, a perennial plant that is part of the buttercup family, and raspberry tea may also provide relief. However, both raspberry tea and black cohosh stimulate estrogen production, which in large quantities may cause undesirable side effects, such as making fibroids grow and stimulating estrogen-responsive tissue in the breasts and in the endometrium.
The diagnostic procedure that provides the most information and has the least risk is a pelvic and transvaginal ultrasound. If an ultrasound reveals a significantly thickened endometrium, it makes sense to proceed with a dilation and curettage (D&C).
Gynecologists often recommend a D&C for heavy or irregular bleeding, but if the cause is a submucosal fibroid, not endometrial thickening, it will worsen the bleeding.
In addition to staying out of an operating room whenever possible, there is good reason to proceed with diagnostic imaging such as an ultrasound before proceeding with a D&C. A risk of frequent D&Cs is Asherman’s Syndrome, a painful condition caused by scar tissue and adhesions in the uterus, which can result in chronic pelvic pain and infertility.
Damage to the uterus as a result of invasive procedures, such as endometrial ablation and uterine artery embolization to stop heavy bleeding, often lead to a hysterectomy. Some procedures may cause irreparable damage to the uterus, ovaries, external genitalia, and other internal organs.
If a doctor tells you that you need a hysterectomy for heavy bleeding or other symptoms that are a manageable nuisance, you probably need a different doctor. If you have symptoms that you feel you need to do something about, there are almost always conservative treatment options.
The female organs have many important lifelong functions, and hysterectomy causes many well documented, permanent, irreversible, and life-altering problems. The most consistent problems women experience after hysterectomy include a 25-pound average weight gain in the first year following the surgery, a loss of sexual feeling, a loss of vitality, joint pain, back pain, profound fatigue, and personality change.
For more information, watch the short video “Female Anatomy: the Functions of the Female Organs.”