Most women in their reproductive years find menstruation troublesome enough when it’s predictable. But many women experience heavy bleeding, called menorrhagia, at some point in their lives, usually during the first years after the onset of menstruation and at perimenopause.
The lining of the uterus—the endometrium—builds up during your monthly cycle, then sheds during menstruation, when women lose from two tablespoons to one cup of blood. Bleeding that soaks more than one tampon or pad every hour for several hours or a period that lasts longer than eight to 10 days is usually diagnosed as menorrhagia. Keep in mind, though, that what is “abnormal” for one woman may be perfectly normal for another. Every woman knows how heavy her flow typically is and for how many days she usually bleeds. If you bleed considerably more heavily than normal or two or more days longer than usual, tell your doctor.
Possible menorrhagia causes can include a hormone imbalance, noncancerous growths in the uterus (fibroids or polyps), cysts on the ovaries, endometriosis (a condition in which pieces of the uterine lining grow outside the uterus), cervical disorders, pregnancy complications, a blood-clotting disorder or a thyroid disorder. Heavy bleeding may also be a sign of cancer of the uterus, ovary or cervix. Although it’s fairly rare for bleeding to be caused by cancer in women younger than 35, it’s important not to ignore your symptoms. For instance, endometrial cancer, a cause of heavy bleeding, can be treated successfully 90 percent of the time—as long as it’s caught early.
Treatment options depend on the cause of the problem. They can include:
Medications. Certain hormone medications are often the first line of intervention.
Dilation and curettage (D&C). Performed under local or general anesthesia, the doctor expands the cervix, then scrapes or suctions the lining of the uterus. At times, small polyps are removed as well, and cells are collected that can be tested further for abnormalities.
Endometrial ablation. Effective for women whose condition has not responded to drugs, endometrial ablation surgically removes or destroys the endometrium (lining of the uterus). It does not require overnight hospitalization, and most women return to normal activities in a day or two. Ablation is a solution for women who wish to avoid major surgery, but this procedure leaves a woman infertile.
Hysterectomy. Hysterectomy—removal of the uterus—is recommended if cancer or a precancerous condition is involved and is considered as a last resort because this, too, leaves a woman infertile.
If your periods are problematic, don’t despair. Most menstrual irregularities can be corrected.