“Dr L I’m 42 and have noticed my periods have been getting progressively heavier over the past six months. My primary care physician did some tests on me and said I wasn’t anemic and not to worry about it but I know this is a sudden change and I know this isn’t my usual period. What should I do?”
Heavy periods regardless of whether you’re anemic or not should be thoroughly investigated.
While I obviously can’t give any specific advice based on such a limited amount of information, I can talk in general terms about heavy bleeding, its detection, evaluation, and treatment.
Why Do Fibroids Cause Heavy Bleeding?
The normal menstrual period usually lasts from 4-6 days and up to 80cc of blood loss (~5 tablespoons). 25% of women your age have bleeding that’s >80cc of blood loss which is called menorrhagia.
For more information on evaluating if your period is too heavy see on of my recent blog pieces “Know Your PBAC Score”.
Menorrhagia can be caused by structural causes which can be detected by radiologic imaging (exs. uterine fibroids, endometrial polyps, or adenomyosis) or non-structural causes which usually require laboratory analysis like a bleeding disorder (coagulopathy) or disorders of ovulation.
Simple blood tests to measure hemoglobin level and platelet count are usually the next step along with a speculum exam and a Pap smear (if not current). If the period lasts longer than 10 days, we recommend adding an endometrial biopsy. The next test would be a transabdominal and transvaginal pelvic ultrasound which is compared to the findings on the physical exam.
Uterine fibroids are the most common reason why women have heavy periods, but there are a number of other causes. The pelvic ultrasound helps to confirm or eliminate them from consideration (exs. fibroids, adenomyosis, endometrial polyp, endometrial hyperplasia).
A special type of ultrasound exam called saline sonohysterogram or hysterosonography can be performed to look for an endometrial polyp or discern between a polyp and a central fibroid. Sterile water is instilled through a thin catheter placed in the uterine cavity while watching under transvaginal ultrasound.
Instilling the saline helps separate the front and back walls of the uterine cavity, and therefore, it can detect very small (mm size) masses that were not seen by standard pelvic ultrasound imaging.
Alternatively, patients can undergo hysteroscopy, which is placing a small scope inside the uterine cavity.
Some physicians perform this in their office (i.e. just like an ultrasound examination).
This offers not only convenience, but also allows for a biopsy to be taken, or if a polyp is detected, it can be removed at the same time.
Can Fibroids Cause Bleeding?
The first-line treatment of heavy bleeding is medical therapy. This is usually some form of hormonal therapy (exs. oral contraceptive pills, levonorgestrel-releasing IUD) or a non-steroidal anti-inflammatory medication (exs. tranexamic acid, ibuprofen). If the bleeding is due to fibroids, the medical therapy often isn’t going to be enough.
In the past this often meant surgery (either myomectomy or hysterectomy). For the past 25 years, a nonsurgical approach called Uterine Fibroid Embolization (UFE) has been available, but most women suffering with fibroids never hear about it.
The Atlanta Fibroid Center is one of the nation’s leading providers of UFE with over 8,000 performed by Dr. John Lipman. To learn more about the Atlanta Fibroid Center, please visit atlii.com or call our office to make an appointment at 770-953-2600.
