How Common is Heavy Menstrual Bleeding?
Up to one-third of women will experience abnormal uterine bleeding in their life, with irregularities most commonly occurring at menarche and perimenopause. A normal menstrual cycle has a frequency of 24 to 38 days and lasts 2 to 7, with 5 to 80 milliliters of blood loss.
The most common cause of abnormal uterine bleeding is a hormone imbalance (typically, too much estrogen or not enough progesterone). Other causes include the following: Ovulation problems, such as polycystic ovary syndrome (PCOS, a condition in which cysts grow on the ovaries, disrupting the balance of hormones).
The most common anatomical causes of abnormal bleeding are uterine fibroids, uterine adenomyosis, or endometrial polyps. Fibroids are benign masses in the muscle layer of the uterus (myometrium), while adenomyosis is a condition in which the lining of the uterus (endometrium) grows into the myometrium.
Diagnosing Heavy Menstrual Bleeding
Imaging
Transvaginal ultrasound is a first-line test to identify structural abnormalities in adults. Magnetic resonance imaging (MRI) may help guide treatment of fibroids.
Blood and Hormonal Testing
Blood tests with complete blood count (CBC) are recommended for all adolescents and women with heavy menstrual bleeding to diagnose potential coagulation disorders (such as von Willebrand disease) or hormonal testing to rule out thyroid disorders.
Hysteroscopy
Hysteroscopy may be indicated when ultrasound is inconclusive, or if submucosal fibroids or endometrial polyps are noted on ultrasound.
Biopsy
An endometrial biopsy may be considered for women aged 45 years and over to test for endometrial cancer.
Solutions
- Observation and regular monitoring may be an option depending on the severity of the patient’s symptoms.
- Hormonal management through an IUD or hormonal injections (Depo Provera) may address or minimize heavy bleeding.
- NSAIDs (non-steroidal anti-inflammatory drugs)
- Myomectomy, the surgical removal of fibroids, is a viable treatment option for heavy bleeding and pain caused by fibroids.
- Hysterectomy or endometrial ablation may be viable surgical options for patients with severe bleeding who do not wish to preserve fertility.
