Heavy
bleeding, called menorrhagia, occurs in 9% to 14% of all women and can
be caused by a number of problems. Long periods (about seven days) and
frequent changes of tampons or pads are not always an indicator of
menorrhagia. Only two-thirds of women who report heavy bleeding actually
lose enough blood to be concerned. Women should consult their physician
if they are consistently changing their pads or tampons more frequently
than every hour or so. Clot formation is fairly common during heavy
bleeding and is not a cause for concern. However, bleeding between
periods or during pregnancy warrants a visit to the doctor. Spotting or
light bleeding between periods is common in girls just starting
menstruation and sometimes during ovulation in young adult women.
You
should have your blood levels checked regularly (every six months),
however, because consistent heavy flows could cause anemia. In fact, the
number-one cause of anemia is a heavy menstrual flow. If this is the
case, have a doctor evaluate you to uncover an underlying cause of your
heavy bleeding. If no specific abnormality is found, the flow can be
decreased with oral contraceptives. Nonsteroidal drugs such as
ibuprofen, taken at the strength of 400 mg every four hours, can reduce
your flow up to 40 percent. Even if ibuprofen doesn't work, this therapy
is harmless at worst.
However,
studies show that many women who complain of an abnormally heavy flow
have lost much less than that. Your own perception of what's heavy is
more important than your doctor's perception, and good doctors will try
to get you to describe your impression of "heavy" and compare
it with your normal pattern. If a doctor tries to determine exactly how
much blood you have, this is a waste of time for both of you. A more
scientific measurement is to simply take inventory of the number of pads
or tampons you're going through and compare that with your normal
pattern.
If
you're over forty, abnormally heavy bleeding is usually caused by what's
known as the "anovulatory period." In this case, you make
estrogen during the first part of your cycle, but for some reason (often
unknown) you just don't ovulate. Therefore, you don't produce
progesterone and you develop an unusually thick uterine lining, which is
expelled during your period. This translates into abnormally heavy
bleeding.
No
matter how old you are, one of the chief culprits of abnormally heavy
bleeding in women is often high doses of ASA (aspirin). So, if you're
fighting off headaches or other ailments before your period, you may
want to use an alternative pain reliever. Sometimes your contraception
method can affect your menstrual cycle. For instance, an IUD
(intrauterine device) or hormonal contraception can sometimes trigger
heavy bleeding. Changes in exercise patterns (usually decreased
exercise) can also affect your menstrual flow.
Treatment
Treatment
varies from woman to woman and has to do with age and reproductive
history. Treatments can include an oral contraceptive containing new
progestin derivatives that help to raise your HDL, the "good
cholesterol" (if you are healthy and don't smoke). In fact,
low-dose contraceptives are absolutely fine right up until menopause, as
long as you have no health problems or risks.
If
you're trying to conceive, on the other hand, a fertility drug such as
clomiphene citrate, will also regulate your cycle and should take care
of the problem.
If
you're between thirty and forty, and don't want to be on contraception,
you can request to be treated with medroxyprogesterone acetate (Provera).
The usual dose is 5 to 10 mg daily ten to fourteen days a month, in a
"two weeks on/two weeks off," cycle. This tends to work better
if you have anovulatory cycles. Finally, a nonsteroidal
anti-inflammatory drug (NSAID) will reduce your menstrual flow. A common
prescription NSAID is naproxen sodium (Anaprox). The usual dose is 275
mg two to four times a day.
If none
of these treatments help, you should be evaluated for more serious
conditions, such as endometriosis, discussed further on.
