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Miserable Once a Month? 9 Health Factors That Affect Your Period

By John J. Cote, MD October 19, 2017 Posted in: Women's Health

When pads and tampons are no match for your monthly period, it’s time to see your OB/GYN.

Heavy menstrual bleeding, or what can seem to women like a raging period, can be incredibly uncomfortable, inconvenient and even painful. Clinically known as menorrhagia, this is a period that is abnormally heavy or lasts for more than seven days. If you’ve experienced it, you’re not alone.

How Heavy is Heavy?

Not sure if you’re what you’re experiencing qualifies as menorrhagia? Keep track for a month or two. Note how much sanitary protection you go through and the presence of clots, including what size. Criteria for menorrhagia includes:

• Soaking through pads or tampons every hour for several hours.
• Using double sanitary protection.
• Needing to change pads or tampons in the middle of the night.
• Heavy bleeding that lasts longer than a week.
• Passing quarter-sized blood clots or larger.
• Heavy bleeding restricts daily activities
• Symptoms of anemia (fatigue, shortness of breath).

Generally speaking, bleeding that significantly impacts your everyday life, is excessive, lasts more than seven days or occurs between periods, after menopause, after sex or during pregnancy -- or just seems different from your norm -- warrants a doctor’s visit.

One in 10 Women has Excessive Bleeding at Some Point

The good news is that we usually slow things down. The first step is determining the cause. During an evaluation, we will check for the following possible causes:

1. Have you changed your birth control or are you pregnant?

Fluctuating hormones are a common cause of abnormal bleeding. Birth control pills and intrauterine devices (IUDs) with hormones tend to lessen flow, while non-hormonal options can cause heavy bleeding temporarily.

Pregnancy can cause spotting or light bleeding around the time of you would normally have had a period. Heavy bleeding can be caused by placenta previa or placental abruption. A miscarriage or ectopic pregnancy can also result in abnormal bleeding.

2. Are you in perimenopause or menopause?

Women as young as 30 can enter perimenopause. During this four- to 10-month transition to menopause, hormone levels can fluctuate and cause irregular bleeding and periods that are longer or are heavier. Any bleeding after menopause is abnormal and warrants a visit with your OB/GYN.

3. Are you on anticoagulants or other medications?

Blood thinners break up clots and can cause heavier bleeding. Even aspirin can increase blood flow to some extent.

4. Do you have a blood disorder?

Two to four million Americans have Von Willebrand disease. Those with this inherited condition have deficient or impaired blood-clotting factor and that can result in abnormal bleeding.

5. Do you have polycystic ovarian syndrome (PCOS)?

As many as one in 10 women have this condition, which results in higher than normal androgen levels that can prevent ovaries from releasing an egg during each menstrual cycle ultimately increasing blood flow.

6. Do you have an infection or sexually-transmitted disease?

Gonorrhea and chlamydia can cause abnormal bleeding and should be promptly treated by your care provider.

7. Do you have a thyroid condition?

One in eight women will develop a thyroid disorder, especially over age 40. An underactive thyroid (hypothyroid) can cause prolonged heavy bleeding; an overactive thyroid (hyperthyroid) can cause unusual bleeding.

8. Do you have an abnormal growth?

Polyps, ovarian cysts, uterine fibroids, endometriosis and pre-cancerous or cancerous tumors can cause abnormal bleeding.

9. Have you gained weight?

Fat cells produce esterone, a weak estrogen. The added estrogen can cause the uterine lining to build up and flow more heavily.

Any of these causes can be at the root of menorrhagia. Definitive diagnosis may require a physical exam, lab tests and possibly an ultrasound. Treatments vary widely from lifestyle changes to medications to surgery, depending on the diagnosis.

My message to women: Don’t suffer in silence. See your OB/GYN. Not only is there relief from heavy periods, we may uncover a health condition that needs treatment.


John J. Cote, MD
John J. Cote, MD

John J. Cote, MD, FACOG is an OB-GYN physician at CHI Health.

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