Normal menstrual bleeding is bleeding that occurs every 24 to 38 days and that lasts up to 8 days. The amount of bleeding is subjective, but heavy bleeding with flooding or soaking through clothes and bedding (more than rarely) might be abnormal. Bleeding or spotting between periods, bleeding or spotting after sex, and bleeding after menopause should also be evaluated.

Abnormal vaginal bleeding may be a sign of a health concern. One of the most common questions or concerns we hear from women is how do they know when they are bleeding too much.

Do you ever have bleeding that is getting in the way of your normal life? Do you feel your life is being controlled by your period? Are you concerned you might be bleeding too much?

You may benefit from seeing a gynecologist to discuss your concerns and understand what options you have.

 

What is normal when it comes to our periods?

Normal menstrual bleeding is bleeding that occurs every 24 to 38 days and that lasts up to 8 days. The amount of bleeding is subjective, but heavy bleeding with flooding or soaking through clothes and bedding (more than rarely) might be abnormal. Bleeding or spotting between periods, bleeding or spotting after sex, and bleeding after menopause should also be evaluated.

For average, non-pregnant, pre-menopausal patients who are experiencing what they consider excess bleeding, we first need to determine what their normal is and how severe the bleeding has become. We ask questions and work together to choose the right treatment plan.

 

What are some causes of abnormal bleeding?

The underlying cause of abnormal bleeding could be related to the woman’s body or the structure of her organs or it could be related to another health issue or disorder.

Some body or structure causes could be endometrial polyps (outpouching of the lining inside of the uterus), fibroids (noncancerous growths of the muscle wall of the uterus), adenomyosis (condition of endometrial tissue trapped within the muscle wall of the uterus making it boggy in texture and can cause heavy bleeding and pain), endometrial cancer or precancer, cervical cancer or precancer.

Health issues causing abnormal bleeding could include coagulation disorder (condition of blood not clotting appropriately such as hemophilia or von Willebrand disease), ovulatory dysfunction (ovary not releasing an egg each month which is very common in the perimenopause period), infection such as chlamydia, endocrinologic disorders such as thyroid dysfunction or bleeding caused by medications or hormones.

 

What is the path to diagnosis?

Evaluation starts with taking a good history of menstruation and also your general health. This can help guide the direction of laboratory testing that might be needed. Your OB/GYN might consider lab tests to look at thyroid studies, blood count, coagulation studies, or liver function.

A good physical exam can assess the pelvic organs for size, consistency, infection, related signs such as multiple bruises or severe anemia. Tests such as sampling of the endometrium, pap test, cultures of the vagina or cervix can also be collected. Another valuable test is a pelvic ultrasound which can reveal any structural issues that could be the root cause of bleeding.

 

Can the bleeding be controlled or treated?

Once testing is complete, each patient works with her OB/GYN and medical care team to determine the best treatment based on test results. In the short-term, bleeding can be addressed with medications such as various different multi-dose regimens of birth control pills, a progestin IUD, oral estrogen, occasionally intravenous estrogen, or a non-hormonal clotting medication called transexamic acid could be tried. Correcting a coagulopathy (blood clotting problem) should be done quickly.

There are also surgical options that can be discussed and the type of procedure will depend on the patient’s desire for future fertility and also whether or not she is stable enough for surgery. If there is a polyp or a fibroid, therapy could be directed at removing the abnormality. A procedure called a dilation and curettage (D&C) would remove a polyp. Removing a fibroid (myomectomy) could help, especially if a patient plans to have children in the future. If future fertility is not a concern, an endometrial ablation or a hysterectomy could be an option. An endometrial ablation is a quick surgical procedure that destroys the lining of the uterus to get it to stop bleeding. A hysterectomy is the definitive surgery to stop bleeding as it removes the uterus.

Treating abnormal bleeding should start with a conversation between yourself and your OB/GYN. There are many options and you should feel comfortable with the treatment. The bottom line is, if you are experiencing excessive bleeding, talk to your physician and know that you have options.

If you are considered, contact Women’s Wellness of Southern Delaware to make an appointment.