What Tests Might Be Needed For Heavy Periods
Your doctor might do or advise one or more of the following tests:
- An examination to see whether the bleeding is coming from your cervix, not your uterus. This is done in a similar way as a cervical smear or HPV screening test.
- Blood tests to look for anaemia, iron levels, thyroid disease or a bleeding disorder.
- An ultrasound of your uterus and ovaries to detect abnormalities in your uterus, such as polyps or fibroids.
- A cervical smear in which a sample of cells is collected from your cervix and then looked at to see if you have an infection, inflammation or changes in the cells that might be or cause cancer.
- A sample of the lining of the uterus to see whether there are any precancerous or cancerous changes.
An Estimate Of How Much Blood Loss During Period
It is possible to calculate how much blood has been lost during period. This depends on the kind of period or menstruation product used.
It is advisable to change your tampon every four to six hours and not wait until they are fully soaked.
To get an estimate of your actual blood loss, multiply the number of sanitary pads used by either 5 ml or 10 ml . The resultant number must be multiplied by 0.36 to get the amount of blood loss.
Blood Loss During Period: What Constitutes Heavy Blood Loss
Blood loss during menstruation comprises about 30 to 50 millilitres of blood, which works out to two or three tablespoons. At the start of menstruation, there are heavier flow days while towards the end, the flow becomes lighter. It is also considered normal to expel small-sized clots.
Heavy blood flow or excessive bleeding is known as Menorrhagia. A woman is said to suffer from Menorrhagia when the blood loss during menstruation is more than 80 ml or 5 tablespoons. Yet another indicator of excessive bleeding are clots bigger than one inch in diameter.
Moreover, if your period lasts for more than seven days, it can lead to heavy flow and is regarded as abnormal. Some women also suffer from Polymenorrhea, or cycles that occur in less than 21 days, leading to frequent menstruation.
Excessive blood loss can lead to losing blood cells, thereby causing iron deficiency and Anaemia resulting in weakness and dizziness.
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Is Heavy Menstrual Bleeding Serious
Heavy menstrual bleeding can be serious if you lose so much blood that you show signs of anemia. Anemia is a condition arising from having too little iron in your body. Anemia can be life-threatening without treatment.
Also, some of the conditions that can cause heavy period bleeding, like cancer, require early medical intervention. Speak with your healthcare provider to discuss any risks related to your period bleeding.
Treatment For Abnormal Uterine Bleeding
Treatment will depend on the cause, but may include:
- medication such as prostaglandin inhibitors, hormone replacement therapy or antibiotics
- dilatation and curettage involving dilation and gentle scraping of the cervix and the lining of the uterus
- change of contraception it may be necessary to explore methods of contraception other than the IUD or hormones
- surgery to remove tumours, polyps or fibroids or to treat ectopic pregnancy
- treatment of underlying disorders such as hypothyroidism or a bleeding disorder
- hysterectomy the removal of the entire uterus is a drastic last resort, generally only considered for treatment of abnormal uterine bleeding when a serious disease, such as cancer, is also present.
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Butwhat About Menstrual Cups
Methods and data on how alkaline haematin yields the quantity of blood already exist in the scientific community. So, thats how researchers achieved the results. I was really surprised. As a menstrual cup user, I thought: How come no new method has emerged since then instead of this seemingly complicated method?
Using menstrual cups just seems so much easier to me than all these mathematical equations and chemical reactions.I tried to find information about using menstrual cups as a method, but I only found vague sources, where a menstrual cup or something similar to it was deemed unsuitable as a diagnostic tool for the quantification of menstrual blood loss .
The justifications were that these devices were not suitable for heavy bleeders and have a generally low acceptability rate within society based on articles from the 90s . But with a clear increase in happy menstrual cup users across the world as well the availability of cups with a higher capacity than the Gynaeseal , this argument is outdated.
So – what now? At this point, I was mostly just confused. Strange images stuck in my head with research assistants washing disposable menstrual products while writing complicated equations on aboard. I hadnt come any further in finding an answer to my initial question: How come there is such a huge difference between my personal period experience and the sources claiming a blood loss of 80 – 120 ml as risky, abnormal, and see a doctor-like?
Is It Normal To Bleed During Pregnancy
Although menstruation during pregnancy is not possible, many women experience vaginal bleeding during pregnancy, especially towards the start. This is called .
This is usually vaginal blood loss caused by the hormonal imbalance characteristic of pregnancy. They do not normally pose a danger to the baby or the mother.
However, if the bleeding becomes heavy and painful, it is recommended to see a gynecologist, as this is indicative of serious complications that can lead to miscarriage.
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What Do Patients Tell Their Gynaecologist
The other more obvious reason why it might be difficult to equate what the pathologist sees with what the gynaecologist deals with is the lack of accurate menstrual loss reporting by patients and their referring doctors. There is, and not surprisingly, a resistance amongst women to collect used towels and tampons so that chemical blood loss measurements can be made in hospital laboratories. However, even if women were to make such collections there are not routine services for measuring loss.
These days many hospital laboratories are filled with very fast robotic machines measuring complex biochemical features on small blood samples. There is simply not the scope for rooms full of large receptacles hydrolysing blood on towels on tampons and then technicians later squeezing them out by hand wearing protective clothing. The experience behind this web site suggests that there is perhaps no need for such procedures if reliable estimates can be made by a trained nurse or by women themselves.
Could there be a way to improve research on dysfunctional endometrial bleeding by helping the patients report menstrual loss better to their doctors? Perhaps www.menstrual-blood-loss.com is one step on the way forward.
What Is A Normal Period
There is a range of normal bleeding some women have short, light periods and others have longer, heavy periods.
Normal menstrual bleeding has the following features:
- Your period lasts for 3-8 days
- Your period comes every 21-35 days
- The total blood loss over the course of the period is around 2-3 tablespoons
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Diving Into The Menstrual Research
First, I investigated the numbers. Websites likeWikipedia report the same as scientific publications on the topic . They all agree that 30 to 50 ml of blood loss during a period is the norm. Only one article from 1998 has a slightly different opinion, stating that too heavy periods start at +120ml . So what is going on here? How come the difference is so significant between my friends perception and mine and the scientific sources about menstrual blood loss? I put on my detective hat and dove even deeper into the bloody subject.
Anemia Due To Excessive Bleeding
, MD, PhD, Johns Hopkins University School of Medicine
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When blood loss is rapid, blood pressure falls, and people may be dizzy.
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When blood loss occurs gradually, people may be tired, short of breath, and pale.
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Stool, urine, and imaging tests may be needed to determine the source of bleeding.
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The cause of bleeding is corrected, and transfusions and iron supplements are given if needed.
The most common cause of anemia Overview of Anemia Anemia is a condition in which the number of red blood cells is low. Red blood cells contain hemoglobin, a protein that enables them to carry oxygen from the lungs and deliver it to all parts read more is
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Excessive bleeding
When blood is lost, the body quickly pulls water from tissues outside the bloodstream in an attempt to keep the blood vessels filled. As a result, the blood is diluted, and the hematocrit is reduced. Eventually, increased production of red blood cells by the bone marrow may correct the anemia. However, over time, bleeding reduces the amount of iron in the body, so that the bone marrow is not able to increase production of new red blood cells to replace those lost.
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Can Women Make Clinically Useful Blood
The blood loss calculator on this site applies the nurses scoring system when she makes real measurements in the hospital. When a choice is made in the calculator her numerical score is attributed to each value and a simple total is produced. It might be that woman who use the blood loss calculator after seeing the online images or printed photos either overestimate or underestimate. The latter is more likely. If it was the research nurse who was doing the scoring based on pictures, the score number might roughly corresponded to the loss in millilitres. Our data suggest that she can easily and reliably discriminate heavy and light loss in real life. Clearly there will be uncertainty around what some would regard as the crucial 80 ml threshold for treatment. .
As yet we do not have clinical research evidence to know how reliably other nurses or women can make clinically useful estimates based on the online images or pictures. Until then we hope that this site, if used wisely, will be helpful.
Perhaps gynaecology nurses, gynaecologists, community based doctors, or the nurses who work with them might also benefit from even a brief look at the site. Those interested in the research background can follow the hyperlinks on the Other information pages.
The Period Math Word Problem You Never Asked For
Question: Say you collect 150 milliliters of period fluid. How much period fluid is blood, and how much is the other stuff? Is the total blood loss amount considered normal?
Answer: Multiply 150 by 0.36 to get a total blood loss of 54 milliliters. This is in the normal range. Then subtract 54 milliliters from 150 milliliters to find that your period contained 96 milliliters of other components like uterine tissues and mucus.
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Key Points About Heavy Period Bleeding
If You Use Menstrual Cups Or Discs
Because they collect the fluid rather than absorb it, menstrual cups or discs will make measuring your blood loss way easier.
Cups typically hold 30 to 60 milliliters at a time, and some even have volume markings to help you track your flow. If your cup is unmarked, just check the packaging or the manufacturers website to find out the capacity.
Discs dont have markings, so youll want to check the packaging or the web to see how much they hold.
During your period, keep a record of how much fluid is in your cup or disc every time you take it out. Do this for your next three or four cycles.
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How Much Blood Do You Lose On Your Period
Many sources claim that people with periods bleed between 30 and 40 ml on average during their menstruation. 60 ml is considered a heavy flow and if you are +80 ml, you are advised to see a doctor. I went to see a doctor, because I honestly started worrying: I empty at least four full Ruby Cups during my period! A Ruby Cup Small can hold 24ml which equals 4x of what a tampon can hold. So my flow is around 100 ml. I went to see my doctor to check with her about my heavy flow, since I actually felt that everything was fine, and luckily she confirmed that I have nocysts, no uterine fibroids, no endometriosis and no thyroid problems.
A little curious, I asked my friends about their experiences and what they told me was similar: those who use menstrual cups mentioned that they had at least 3 full cups during the first days. So again, a minimum of 80 to 120 ml of blood loss during their period was the most common quantity. So how come we, according to some research, should go see a doctor because of excessive flow? This seemed weird to me. Heavy periods can of course be an emotional burden for some and if your heavy period is intervening with your daily life, it’s definitely a sign to go see a doctor. You should not have to suffer and there are solutions. But thats the point: none of us seemed to be suffering from our apparently”excessive periods”. And so I began my research.
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What Is Heavy Menstrual Bleeding
Heavy menstrual bleeding is when your periods are extremely heavy or prolonged. “Heavy” means that your period lasts longer than seven days or that you lose more blood than is typical during menstruation. You may bleed so much that you have to change your tampon or pad every hour for several hours back-to-back. You may pass blood clots the size of a quarter or even larger.
Menstrual bleeding that’s so heavy that it interferes with your daily life is never normal. Your provider can recommend treatments to manage heavy blood flow.
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The Combined Oral Contraceptive Pill
This reduces bleeding by at least a third in most women. It often helps with period pain too. It is a popular treatment with women who also want contraception but who do not want to use the LNG-IUS. If required, you can take this in addition to anti-inflammatory painkillers , particularly if period pain is a problem. See the separate leaflet called The Combined Oral Contraceptive Pill for more details. Other options which work in a similar way are combined hormonal contraceptive rings or patches.
A Bonus Note For Clinicians/ Menstrual Health And Rights Enthusiasts
A few years ago, it was decided to just trust that people who sought help from their doctor for very heavy periods, really did have them . This is actually a very nice intention a decision to believe in female patients rather than dismiss them as prone to exaggeration . Unfortunately, menstruation education is typically of poor quality and so people who menstruate often do not have an informed idea if their flow is average, heavy- or even heavy enough to be Heavy Menstrual Bleeding .
It has been argued that it is better to treat all of those who think they have this condition, rather than measuring fluid/ blood loss or otherwise making a diagnostic distinction . However, I am concerned that by doing this we are actually reinforcing a sexist myth that positions all menstruating people as debilitated , as well as normalising the exceptionally severe experiences of those few who really do lose over 80 ml of blood per period .
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What Did My Wife Know
In order to find out whether or not women did have a visual reference for assessing loss I asked my wife whether anyone had ever shown her used sanitary towels either as girl, as a medical student or when she was undertaking a post-graduate medical diploma in obstetrics and gynaecology. No, not even when she was training in the most medically relevant speciality. I then asked my sister rather sheepishly, then my mother, and then some of my female colleagues.
It was clear that the site of menstrual loss had become a taboo, at least in this country. Even if a woman were to show her doctor, gynaecologist or nurse what an example of heavy loss looked like would they know? By consulting www.menstrual-blood-loss.com they would at least have a better idea.