Help for Women with Heavy Menstrual Bleeding

Period pain is a living reality for many. And for women who have heavy menstrual bleeding, they experience more than just greater blood loss. They also endure severe pain, fatigue and weakness, headaches and anemia.

“Statistically, we know that 40% of women who have heavy bleeding don’t perceive it as a condition,” said Dominique Boadwine, MD, Avera Medical Group obstetrics/gynecology specialist. “That’s why having a conversation with your provider annually about your bleeding profile is important.”

A regular menstrual cycle takes place every 21 to 35 days and lasts between five to seven days – with the average amount of blood loss being around 50 milliliters. During a regular or irregular cycle, abnormal uterine bleeding (AUB) can occur.

“If you’re bleeding through a pad or tampon every two hours or for a prolonged period of time, such as two weeks out of the month, this would count as abnormal,” Boadwine explained.

Causes of Heavy Periods Symptoms

It is possible to reduce the pain and impact of heavy menstrual bleeding on your life. Since it can be the result of many conditions affecting your uterus, knowing the cause is key to finding the right treatment. Physicians use an acronym for the causes of abnormal bleeding, known as PALM-COEIN (pronounced palm coin).

“This mnemonic device benefits patients by educating them on the primary cause of the heavy bleeding,” Boadwine explained. “They can then make more informed decisions regarding their care.”

PALM refers to structural abnormalities:

• Polyps: common benign growth (or small clumps of cells) in the endometrium or cervix
• Adenomyosis: occurs when endometrial tissue exists within and grows into the uterine muscular wall, enlarging the uterus
• Leiomyomas: benign growth in multiple areas of the uterus (often called fibroids)
• Malignancy and hyperplasia: serious condition that happens when the inner lining of the uterus (endometrium) becomes too thick, may relate to gynecologic cancer

COEIN refers to non-structural causes:

• Coagulopathy: underlying bleeding disorder
• Ovulatory dysfunction: condition more often associated with irregular cycles that can be due to hormonal or metabolic imbalance, or an underlying eating disorder
• Endometrial: means the cause may lie in the ovulatory cycle without structural or systemic abnormalities, such as clotting or impaired blood movement
• Iatrogenic: outside causes that most often are due to some sort of medication, like an anticoagulant or improperly used hormone-based medication
• Not otherwise classified as the cause may be a systematic disease, such as endometritis (infection in endometrium a.k.a. innermost glandular layer of the uterus)

Treatment Options for Less Pain

The treatment right for you will depend on your health history, a physical exam and sometimes diagnostic imaging to get a better view of the uterine lining. This can involve a review of bloodwork and possible screenings for blood disorders. Some exams may include a pregnancy test, sexually transmitted infection (STI) test or an endometrial biopsy to be certain of the cause.

Abnormal uterine bleeding can happen to women of any age. Patients with postmenopausal bleeding should see their physician right away. Unusually heavy menstrual bleeding could put you at greater risk for developing uterus or uterine lining cancer. Other risk factors include prolonged estrogen exposure, elevated body mass index (BMI) and family history.

“With all that is known of hereditary cancer, I encourage my patients to have a conversation with their family members to understand their genetic history of cancer,” said Boadwine. “We can then provide screenings to patients based on their specific needs.”

Come see Dr. Boadwine and other great OB-GYN physicians who provide quality women’s health services at Avera.

Read More Like This:

• Periods Earlier, Menopause Later: What’s the Big Deal?
• Know the Symptoms of Gynecologic Cancer
• Perimenopause 101: Signs, Symptoms & Treatments