Extreme bleeding can cause iron deficiency, chronic anemia and fatigue. It can even cause issues with mental health and cognition.
By Deborah Jeanne Sergeant
Women with abnormally heavy and painful menstruation should not ignore the issue.
Most women experience a period that lasts two to seven days and expel two to three tablespoons of blood over that timeframe.
Minimal cramping or managing cramping with over-the-counter medication is normal. However, extremely painful, debilitating cramps are not. The latter can cause women to take sick leave.
“This is our bread and butter as OB-GYNs: managing folks who have this issue,” said physician Elana Tal, in general obstetrics and gynecology at UBMD Obstetrics & Gynecology. “We have a lot of treatment options. Because this is a quality-of-life issue, a lot of times those treatment options can be preference-based. Once we realize it’s not something serious, treatment can range from medication to minor or major surgery.”
Tal is a clinical assistant professor at Jacobs School of Medicine and Biomedical Sciences, University at Buffalo.
For example, extreme bleeding can cause iron deficiency or chronic anemia. Women may experience chronic fatigue. It can even cause issues with mental health and cognition. More serious conditions could also cause their period problems.
Many women delay seeking help for heavy periods. If care providers minimize their concerns, women may think they’re “being wimps” for speaking up and asking for help. Beyond stoicism, they may also fear a diagnosis of cancer or a disease in their reproductive system.
“It can be a sign of precancer, cancer, fibroids, tumors that aren’t cancer in the uterus, polyps,” Tal said.
She said that care providers rely on the patient’s account of how many pads or tampons she uses to estimate if she is experiencing heavy periods. The visit may include a thorough history, pelvic exam, blood work and ultrasound of the uterus and ovaries.
“There’s no need to suffer,” Tal said. “Historically in our patriarchal society, there’s been some messages that periods are a ‘woman’s lot in life’ and something they have to suffer through and that’s not true. If your periods really bother you, you can take control of your health and advocate for what you need from a healthcare clinician.”
She encourages women to seek a second opinion if they feel their provider is not listening to them.
The thought of various treatments may prevent them from seeking help. Treatment for heavy periods does not always mean surgery. Non-hormonal medication, hormonal medication and other approaches may solve the problem. As to which is appropriate depends upon other health factors and the patient’s preference.
Heavy periods do not often indicate a serious issue. In fact, “most likely, there’s nothing seriously wrong and there’s a treatment that can give them relief,” said Carol Peterson, physician and assistant professor at URMC.
“It’s important to pay attention to this because most of us don’t have lifestyles that can sustain four to five days of cramps and misery,” she added.
Very heavy periods could also indicate fibroids, endometriosis or cancer. Even these more serious diagnoses can potentially be treated. But the first step is to seek help from a provider.
“Talk with your doctor and figure out what’s going on,” Peterson said. “You can take medication that help decrease the flow. We have lots of ways to treat heavy periods. You may have a form of hemophilia, which is treated in a different way. Some just have very heavy periods but can be treated.”
For very heavy bleeding, tampons and pads may need changing more than is convenient. Washable period underwear can also provide an additional barrier of protection against leaks.
Menstrual cups and disks require less frequent attention and are reusable, saving money and landfill space. Using a cup can also help women know exactly how much they’re bleeding as some cups include measuring marks. This information can be helpful when talking with a healthcare provider.
Women should discuss with their healthcare provider how to address heavy periods and how treatments relate to their other health concerns and any medications.