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Heavy Bleeding in Premenopausal Women: How Much Is too Much?

In our earlier blog posts, we discussed many uterine fibroid symptoms, and the key symptom is often heavy menstrual bleeding (or sometimes bleeding between periods). However, when it comes to premenopausal women, sometimes it’s hard to tell whether or not bleeding is abnormal or heavy; after all, your body experiences many changes preparing for the menopause, and what once was normal is no longer true.

Related: Heavy Menstrual Bleeding with Clots and Pain

For premenopausal women, bleeding during period should be less than 5-6 tablespoons of blood. If you bleed more than this, it should be checked out by a physician. A history, a physical exam, and some blood work will rule out a number of less common causes for heavy bleeding in premenopausal patients (ex. effects of certain medications, thyroid condition, pituitary tumor).

If the bleeding is cyclical, often patients are placed on a hormonal agent (ex. birth control pills or IUD). If the cycles are more irregular or in premenopausal women, a biopsy of the lining may be performed (endometrial biopsy). If the bleeding is not controlled and the biopsy is normal, pelvic ultrasound is often the next step to look for fibroids (the most common cause of heavy bleeding). If there are uterine fibroid or adenomyosis (or both), it’s important to know about the treatment option called Uterine Fibroid Embolization (UFE) as most physicians fail to mention it, and instead focus only on the surgical options (ex. myomectomy or hysterectomy) at this point. UFE treats all of the fibroids (irrespective of their size or number). The procedure is done as an outpatient with patients going home with just a simple bandaid and typically returning to work within 1 week.

If there are no fibroids or adenomyosis, a saline sonohysterogram or hysteroscopy is performed to look for a uterine polyp or other uterine lining pathology. If there is a polyp, it will be removed and this should alleviate the bleeding. If there is no uterine lining pathology seen (or a polyp), and the patient is not interested in fertility, she could undergo endometrial ablation. The ablation burns the lining and will significantly decrease (or in some cases, end) the bleeding. Ablation should be reserved for women without fibroid-related bleeding. For women with fibroid-related bleeding, the problem is not the lining but the fibroids that must be treated.

Burning the lining with an ablation in patients with uterine fibroids often doesn’t significantly improve the bleeding and to make matters worse, it does not address the bulk-related symptoms (ex. pelvic pain, increased urinary frequency, anemia, painful sex, etc.) that the fibroids cause.

For more information on fibroids, adenomyosis, and UFE please visit our website ATLii.com or call to make an appointment for a consultation at 770-953-2600.