How Is Menorrhagia Diagnosed
Diagnosing menorrhagia has two parts: confirming that your bleeding is unusually heavy, and identifying the underlying cause.
For the first part, your doctor will ask you questions about your medical and menstrual histories. For the second part, one or more tests may be used. Examples include:
- A blood test to check hormone levels and look for signs of anemia or clotting issues.
- A Pap test, where cells from your cervix are examined for signs of infection, inflammation or other unusual changes.
- An endometrial biopsy, which involves taking samples from your uterine lining. The samples are looked at to see if any unusual or cancerous cells are present.
- An ultrasound, which uses sound waves to check for dysfunction in the pelvic organs, as well as blood flow issues.
- A sonohysterogram, another kind of ultrasound thats done while your uterus is filled with liquid to get a better look at the uterine lining.
- A hysteroscopy, where a very small, flexible camera is used to examine the uterus for fibroids, polyps and other possible causes of bleeding issues.
Signs That You Have Abnormal Blood Loss
There are a few key signs that your period is heavier than normal and you may be losing a harmful amount of blood.
1. Bleeding too much: Its a sign of menorrhagia if you need to double up on pads or have to change your pad in the middle of the night, says Astrid von Walter, MD, an OBGYN at Rockville Gynecology.
2. Bleeding too quickly: If you soak through a tampon or pad in less than an hour, for several hours in a row, this is a sign that youre bleeding too much and you should get medical attention as soon as possible.
3. Bleeding for too long: Its also concerning if you have heavy periods lasting more than 7 days, von Walter says.
Its also common to have cramping along with heavy bleeding, or feel weak and fatigued, von Walter says.
You should also ask yourself how your period affects your quality of life, Greves says. If you are having to change your activities etc. and revolve things around your period because it is too heavy, then that is not normal.
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If You Use Menstrual Cups
This is probably the easiest way to measure your menstrual blood loss. Many cups include measuring marks, and you wont have to account for any amount of blood absorbed by the product. Even if your cup doesnt have any measurements, this information tends to be available online or on the cups packaging.
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Cervical Or Endometrial Cancer
Endometrial cancer occurs when abnormal cells in the endometrium grow into the uterus and/or other organs. While the cause of endometrial cancer is unknown, the most common age for diagnosis is the mid 60s.
Treatment for endometrial cancer is usually a hysterectomy, possibly followed by chemotherapy and/or radiation treatments.
Early diagnosis is key to the effective treatment of cancer. In addition to regular Pap screening for cervical cancer, the American Cancer Society recommends that women at high risk of endometrial cancer have an annual endometrial biopsy.
How Can You Tell How Much Youre Actually Bleeding
You expel more than just blood during menstruation. Your menstrual fluid also contains a mix of mucus and uterine tissues, which can add volume to your overall fluid loss. Thats what makes measuring blood loss tricky.
But its definitely possible. The hygiene products you use can help you get a rough estimate of your overall flow. And if you want an accurate account of pure blood loss, math is on your side.
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What Causes Heavy Menstrual Bleeding
Heavy menstrual bleeding can have many causes, ranging from hormone-related issues to various medical conditions and even stress.
The hormones that your body produces, like estrogen and progesterone, help regulate your menstrual cycle, including how heavy your periods are. Having a condition that causes your hormones to become imbalanced can lead to heavy period bleeding. Causes include:
- Birth control pills and injectables .
Failing to remove contraceptive devices when needed can also cause abnormal uterine bleeding.
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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I Discovered There’s An Equation That Calculates Menstrual Blood Loss
I made an incredible discovery: I found an equation . A statistical equation to calculate menstrual blood loss, can you imagine!? I studied statistics and I know about the thrill of finding a great equation with precise estimations but an equation for menstrual blood loss? Isnt this a very complicated way to assess something really easily measurable with a menstrual cup? The equation is based on women keeping a diary and focuses on the following factors:
- The number of days when heavy, normal and light bleeding is experienced
- the haemoglobin and serum ferritin values
- as well as age.
When Is A Heavy Period Too Heavy
- By Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing
Its common for girls and their parents to wonder if the bleeding with their periods is too often or too much. Especially in the first few years of having a period, any bleeding can feel like too much. Usually, its not but sometimes it is, and its important for parents to know what to watch for, and when to call the doctor.
In the first couple of years after periods begin, its really normal for periods to be irregular and for some of them to be heavy. At the beginning, periods arent associated with ovulation, and the hormones and hormonal patterns that help regulate periods havent fallen into place yet. If its just the occasional period that is heavy, thats usually nothing to worry about.
Its not always easy to know what counts as a heavy period. As I said, for some girls anything is too much. And while we doctors often ask how often the girl changes her pad or tampon, thats very subjective and dependent on personal preference. Some girls change as soon as there is any blood present or every time they use the bathroom. Others wait until they are completely soaked.
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Signs You Are Losing Too Much Blood During Period
Every month the cycle repeats and the days come when you go through a phase wherein you lose blood. Blood loss is a part of a womans normal life. But the loss in the blood isnt quantified. At times you might lose more blood than usual or you might bleed less.
This natural process is known as menstruation or periods. The menstruation cycle is of 2830 days and you bleed every month for 37 days. The days are associated with mild pain and cramps and for some these days can be with immense pain.
Heavy bleeding is a major concern among women. Heavy bleeding can disrupt your daily living. It can give you intense pain, leakage, cramps, and other health-related problems as well.
But since you cannot quantify the blood how you would come to know whether its bleeding heavily or not. How do you determine that you are bleeding heavy or light?
Look for signs and symptoms that will tell if you bleed more. Guess what are they? Let me tell you guys. These symptoms are easy to notice and when you observe them in your periods blood it means you are bleeding heavily.
Signs which would help you recognize if you lose too much blood.
If you are suffering from any of these signs you might bleed heavily in your periods. But hey! You are not the only one. There are many like you and also these signs do not mean you have a serious problem. Though its unpleasant and troublesome, it can be normal too. The doctor will better tell you about it.
Causes for heavy bleeding
How Do You Know If Your Bleeding Is Too Heavy
It is very difficult to determine whether your bleeding is too heavy. The best guide is to decide whether your period is having an impact on your quality of life if it is causing you to be housebound, interrupting your daily activities, or causing you stress and anxiety. The following signs might indicate you are experiencing heavy bleeding:
- bleeding or âfloodingâ not contained within a pad/tampon
- changing a pad/tampon every hour or less
- changing a pad overnight
- clots greater than a 50-cent piece in size
- bleeding for more than seven to eight days.
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When Its Time To See A Doctor
You know your body best, so if you feel like youre bleeding too much, you probably are. If youre concerned that your period is too heavy or if its interfering with your daily life, it may be time to see your doctor.
Your doctor will ask you about your menstrual cycle, heavy bleeding and other symptoms you are experiencing. They will ask about your family medical history, and they may run bloodwork and check iron levels, a sign of anemia and blood loss.
For the first few years of your period, there may be months where you dont ovulate, called anovulatory cycles. This is normal but can cause some inconsistencies with your uterine lining and may lead to heavy or irregular bleeding.
Sometimes, a heavy period can be an indicator of a more serious problem. Common conditions that can cause heavy menstrual bleeding include:
· Hormonal disorders. Hypothyroidism and other hormonal disorders can cause heavy bleeding both during your period and bleeding before or after your period, called breakthrough bleeding.
· Fibroids. Noncancerous growths that develop along the lining of the uterus and can cause heavy, painful periods.
· Von Willebrand disease. A hereditary blood disorder caused by either not having enough Von Willebrand factor a protein that helps form blood clots to stop bleeding or having VWF that does not work as it should. As many as 20 percent of adolescents with heavy periods may have this disorder.
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.
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What Is The Typical Period Volume For People On Hormonal Birth Control
Hormonal birth control options like the pill, vaginal ring, or patch control the release and regulation of hormones like estrogen and progesterone within your body. When used correctly, the hormones in HBC prevent your ovaries from preparing and releasing eggs .
Your period will change depending on the type of HBC you use. Bleeding typically happens during your âno hormoneâ days . The bleeding you experience while using hormonal birth control is called withdrawal bleeding, and is not considered a menstrual period. Withdrawal bleeding is caused by the decline in reproductive hormones in your body during days when you get low or no hormones from your pill, patch, or ring .
Many people experience lighter bleeding and some donât bleed at all while using hormonal birth control . When affected by hormonal birth control, the lining of your uterus doesnt thicken as much as it does without hormonal birth control. This typically results in lighter, shorter, or occasionally absent âperiods,â especially for people who have been using hormonal birth control for many months or years.
What Can You Do To Feel Better
If you have severe cramping during your periods, taking an NSAID such as ibuprofen or naproxen may help. An NSAID works best when you start taking it 1 to 2 days before you expect pain to start. If you dont know when your period will start next, take your first dose as soon as bleeding or cramping starts.
Heavy periods can make you feel weak and run-down and can lead to anemia. Your doctor may suggest that you take an iron supplement if your iron levels are low. You may be able to prevent anemia if you increase the amount of iron in your diet. Foods rich in iron include red meat, shellfish, eggs, and beans.
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Signs And Symptoms Of Heavy Menstrual Bleeding
Symptoms of heavy menstrual bleeding may include:
- Soaking through one or more sanitary pads or tampons every hour for several consecutive hours
- Needing to wake up to change sanitary protection during the night
- Needing to use double sanitary protection to control the menstrual flow
- Menstrual bleeding that lasts longer than a week
- Symptoms of anemia, like fatigue, light-headedness and shortness of breath
- Passing blood clots larger than a quarter
- Restricting activities because of heavy menstrual flow
When To See A Doctor
Period blood clots are a normal part of your menstrual cycle. But when you notice any changes to the size and amount, it could point to an underlying condition. When speaking to your doctor, be prepared with the following information:
- How long your period usually lasts.
- How heavy your usual flow is.
- If youve been bleeding between periods.
- If youve noticed changes over time.
- If youve been experiencing pain.
- If theres a chance you might be pregnant.
- A list of medications you are currently on.
- A list of other medical conditions.
Expect your doctor to do a pelvic exam. They may also want to do a blood test, a pap test or an ultrasound during your visit.
After an exam and testing, your doctor may prescribe the following based on the results, how severe the clots are and your other symptoms:
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When Should I Be Concerned About Blood Clots During My Period
Having a period is normal. And while a menstruation cycle can vary in length, amount and frequency, menstrual blood clots can be a scary thing when you see them. Most blood clots during a period are normal, but if you experience large blood clots and notice changes in your period, it may be time to talk to a doctor.
Symptoms Of Abnormal Uterine Bleeding
- bleeding for more than eight days
- heavy blood loss during the menstrual period for example, soaking through one or more sanitary pads or tampons every hour for several hours in a row
- needing to change your pad or tampon during the night
- have to change or restrict your daily activities due to your heavy bleeding
- bleeding or spotting between periods
- cramping and pain in the lower abdomen
- any vaginal bleeding after menopause.
If you think you may be experiencing heavy menstrual bleeding, you may find it useful to keep a pictorial blood loss assessment chart this can help you give your doctor an idea of how heavy your period is.
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When Is Menstrual Bleeding An Emergency
It can take a serious toll on your body when a significant amount of blood is lost every month. Dont hesitate to seek emergency care if you experience new or severe symptoms related to heavy menstrual bleeding.
Uterine lining is rich in iron, so you lose iron every time you have your period. Heavy periods can be linked to anemia. Anemia occurs when your body doesnt have enough of certain blood cells or when blood cells arent functioning properly.
Anemia can make you feel: