Abnormal bleeding is stressful and can disrupt your life. There can be different causes as women age. Evaluation is important as abnormal bleeding can be a symptom of a more serious condition.
If you have to schedule your life around your period, then your bleeding is too heavy or painful. Treatments are available so you can return to your active lifestyle.
The most common reasons for heavy periods are:
- Abnormal hormone levels effecting ovulation
- Uterine polyps or growths in the uterine lining (endometrium)
- Uterine fibroids or growths in the muscle of the uterus
Abnormal Hormone Levels Effecting Ovulation
The Menstrual Cycle
Before we discuss treatments for heavy bleeding we need to talk about the causes. Normal, regular periods are the result of a normal menstrual cycle. The menstrual cycle starts with the first day of your period and goes through these three phases:
- Menstruation Phase – Your period is when the lining (endometrium) of your uterus is shed with bleeding that typically lasts 3 to 5 days and can be accompanied by cramping, breast tenderness, bloating and irritability. These symptoms can be worse as your bleeding gets heavier.
- Proliferative Phase – As your period stops you are starting the process of the release of another egg (ovulation) for your next cycle which is called the proliferative phase. As the egg prepares to ovulate it causes a hormone called estrogen to increase and this starts the growth, or proliferation, of the uterine lining to prepare for pregnancy.
- Secretory Phase – When estrogen levels peak a hormone in the brain is released which leads to ovulation and this starts the secretory phase. With ovulation a hormone called progesterone is formed which stabilizes the lining of your uterus for the implantation of a fertilized egg. When the egg is not fertilized the progesterone level falls and this triggers your period.
What Causes Abnormal hormone Levels
When hormone levels do not rise appropriately and peak, estrogen continues to make a lining but ovulation does not occur and progesterone is not made. Without progesterone, the lining is not stabilized and this can lead to unpredictable, heavy bleeding as it “crumbles down”. Polycystic ovarian syndrome (PCOS) or thyroid abnormalities can also cause abnormal hormone levels.
Uterine polyps or growths in the uterine lining (endometrium)
Uterine Polyps can be formed when hormone levels are abnormal which leads to irregular ovulation and periods. The endometrium does not completely shed without a regular period and this buildup creates polyps. These polyps hang in the uterine cavity like an icicle in a cave. When the endometrium sheds it pulls away from it’s blood supply and this stops the bleeding. Polyps don’t shed as easily so they continue to bleed like a faucet that cannot be turned off.
Uterine fibroids or growths in the muscle of the uterus
Uterine fibroids form as a result of the abnormal growth of a muscle cell in the wall of the uterus. The muscle cell multiplies causing a ball of hard tissue to form. Fibroids can range in size from a pea to a watermelon. Most fibroids are golf to tennis ball size and women often have multiple fibroids. We don’t know what initiates the growth of fibroids, but estrogen promotes their continued growth. As estrogen levels decline in menopause they can shrink and even go away. They tend to run in families, are rarely cancerous, but can cause heavy bleeding and pain.
Abnormal bleeding often occurs when patients do not know they are pregnant. This bleeding can be the result of a miscarriage or a placental abnormality. If you are having abnormal bleeding and there is a chance that you may be pregnant, you should take a pregnancy test right away. If the pregnancy test is positive, you should call Women’s Health Wise at 303.776.5820 immediately.
Treatments for abnormal bleeding:
Most women have regular periods, however it is common to have an irregular, heavy period every once in awhile because of an abnormal ovulation and it may not need evaluation or treatment. Health conditions, weight changes, stress and travel are some of the things that can interfere with your regular cycle. If the irregular cycles begin to happen more than once in a six month time frame or become significantly heavier or more painful, you should schedule an appointment at Women’s Health Wise for evaluation.
- Non-Steroidal Anti-inflammatory Drugs (NSAIDs)
- Non-Steroidal Anti-Inflammatory Drugs such as aspirin, ibuprofen and Aleve (naproxen sodium) prevent the formation of inflammatory compounds and thereby decrease pain and cramping with your period. They can also decrease bleeding. It is important to start taking these medications as soon as you feel the bleeding and cramping are about to begin.
- Hormonal Treatments
- Hormonal contraception, such as birth control pills, Nuvaring, and Depo Provera can be used as a treatment for heavy bleeding and pain.
- Hormonal IUDs such as the Liletta, Mirena, Skyla, and Kyleena release a small amount of progesterone into the uterus and can also be used as a treatment for heavy bleeding and pain.
- Lupron is an injectable hormone that suppresses your period completely and can be particularly effective when uterine fibroids are the primary cause of the bleeding.
- Hysteroscopy uses a thin camera called a hysteroscope inserted through the cervix to look inside the uterus. Uterine polyps and fibroids can be diagnosed and treated with hysteroscopy. The uterine lining (endometrium) can be removed by doing a D&C (Dilation and Curettage) at the time of hysteroscopy to treat heavy bleeding. This can be done in the office with medication or as an outpatient procedure at a Surgery Center.
- Endometrial Ablation Treatment
- An endometrial ablation can be performed after a hysteroscopy to permanently prevent recurring episodes of heavy bleeding. We have dedicated an entire page to this treatment methodology. Click here for further information about Endometrial Ablation.
- A hysterectomy is when the uterus is removed. The ovaries can be left in place so they will continue to produce hormones and therefore a hysterectomy does not mean a woman will undergo hormonal changes or begin menopause. We have dedicated an entire page to hysterectomy. Click here for more information.
Heavy bleeding can lead to anemia or be a sign of pre-cancerous or cancerous changes within the uterus and should be evaluated. Call and make an appointment with Dr. Lane at Women’s Health Wise to further discuss the options above and select your best treatment option.