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Published on July 06, 2017

tampons and pads for heavy periods

Help for Women with Heavy Menstrual Bleeding

Women with heavy menstrual bleeding know it’s more than just bleeding. It comes with pain, fatigue and weakness, headaches and anemia.  

If you face this condition, you’re already aware that abnormal uterine bleeding (AUB) is unpleasant. But treatment can help reduce its impact.

Avera Medical Group Marshall Physician Lauren O’Brien, MD, said AUBs definition can vary greatly.

“When a woman has blood loss equal to soaking a pad/tampon every two hours or prolonged bleeding that lasts longer than seven days, she is facing this condition,” she said.

For most women, a normal menstrual cycle is defined as cycles every 21 to 35 days. The typical cycle lasts between five to seven days. AUB can happen in regular or irregular cycles. 

“The signs of AUB can include heavier or prolonged bleeding compared to previous years, clots with bleeding over multiple days and they can cause other symptoms of anemia, which may include lightheadedness, dizziness, exercise intolerance, breathing trouble and headache,” O’Brien said.

Physicians use an acronym for the causes of AUB: PALM-COEIN.

O’Brien said “PALM” refers to potential structural abnormalities, such as:

P: Polyps. Endometrial or cervical polyps are common benign growths, typically not painful.

A: Adenomyosis. This growth of the uterus lining within the muscle of the uterus is similar to endometriosis, and women who experience it may have enlarged uteruses with heavy bleeding. It’s often painful.

L: Leiomyomas. This is another name for fibroids, benign growths located within multiple areas of the uterus. They may be parts of the heavy bleeding or pain, but they also can occur unrelated to these symptoms.

M: Malignancy/hyperplasia. This is the most serious concern for women, for the bleeding may relate to a gynecologic cancer.

“Risk factors for this group of cancers includes prolonged estrogen exposure, family history, personal history and elevated body mass index (BMI),” she said. “Women who experience postmenopausal bleeding or who have faced polycystic ovary syndrome (PCOS) also have higher risk of gynecological cancers.”

The second part of the acronym is COEIN, and it refers to potential non-structural causes:

C: Coagulopathy, which is an underlying bleeding disorder.

O: Ovulatory dysfunction, a condition more often associated with irregular cycles. It can be due to hormonal or metabolic imbalance, and sometimes an underlying eating disorder can cause this.

E: Endometrial, which means the cause may lie in the ovulatory cycle without structural or systemic abnormalities, such as clotting or impaired blood movement in this part of a woman’s body.

I: Iatrogenic, which means simply “outside causes.” O’Brien said that most often some sort of medication, like an anticoagulants or improperly used hormone-based medication, is part of this cause.

N: Not otherwise specified. Here the cause may be a systematic disease, such as endometritis, which is an infection within the endometrium, the innermost glandular layer of the uterus.

“When I work with women, we complete a thorough medical history and physical exam, and that can include potential diagnostic imaging,” she said. “A pelvic ultrasound, CT, or an MRI can help us get information. In some cases we will use a sonohystogram, which is a special ultrasound where we put fluid into the uterus. It gives us a better view of the uterine lining.”

O’Brien said she’ll often review a woman’s bloodwork and review possible screening for blood disorders. In some cases a urine pregnancy test, a liver function testing or STD test will be part of the exam. Doctors also will evaluate you for underlying metabolic disorders like insulin resistance, and some women may need an endometrial biopsy to be certain of the cause.

“Treatment can vary from medical to surgical management, depending on the patient’s age, health history and other factors,” she said. “There are numerous options, but they depend on your health history, and in some cases we consider surgical options. If you’re facing this painful discomfort, do not delay treatment. It can help you feel better.”

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