Heavy Menstrual Bleeding

Have you needed to replace your regular tampons with a super or super plus?

Have you started soaking through your overnight pads?

Are you using up more sanitary products than usual because you are changing them more frequently or bleeding for more days?

If you answered yes to any of these questions it is likely that your periods have become longer (more than seven days) or heavier or both. 

It is important that you talk to your gynecologist.

When your period comes at the same time every month even though your bleeding has changed you are still ovulating.  In order to have a regularly timed period, you have to be ovulating. The old term for this kind of abnormal uterine bleeding is menorrhagia, which comes from a Greek stem meaning to burst.  (I am sure that creates a pretty accurate image for some readers!)

Why does it matter if I am ovulating or not?

When your cycles are coming at regular intervals it means you are ovulating. It means that your ovaries are producing the hormone progesterone and shedding the lining of the uterus (endometrium) at the normal time.  This is important because both of these things protect the lining of your uterus from becoming abnormal a process called endometrial hyperplasia. This kind of change in the lining of your uterus can increase your risk of developing endometrial cancer. If you are bleeding heavier but at regular intervals the chance that you have potentially precancerous changes in the lining of your uterus is minimal.

What will happen when I see my gynecologist?

When you go to see your gynecologist she will ask you the questions that will determine that you have ovulatory abnormal uterine bleeding.

You probably will also have a physical exam and a pelvic exam.

Based on this history and your pelvic exam, your gynecologist may consider ordering the following tests:

Pregnancy test:

Even though it is likely that you are not pregnant since your cycles are coming regularly a urine pregnancy test may be performed. It is simple, inexpensive, and noninvasive.

Complete blood count (CBC):

This is a blood test. If you have been having heavy periods it is important to check to see if you have developed anemia. This test also checks to see if you have developed low platelets or thrombocytopenia

Thyroid stimulating hormone (TSH):

Disorders of your thyroid can affect your period.  Hypothyroidism or an underactive thyroid is most likely with this type of abnormal uterine bleeding. Your gynecologist will decide if this test is appropriate for you.

Other blood tests:

Based on your history and physical exam your gynecologist may order additional testing to rule out other causes of abnormal bleeding which could be making your menstrual bleeding heavier or longer. These tests may include:

Liver function tests to exclude liver disease

Tests for hereditary bleeding disorders the most common is Von Willebrand disease (vWD)

Chlamydia testing :

Chlamydia trachomatis is a sexually transmitted disease. It can cause inflammation of the lining of the uterus that causes heavy bleeding with your period. If your gynecologist thinks you are at risk for Chlamydia she may recommend testing.

Pelvic ultrasound:

Structural changes in the uterus are a common cause of heavy menstrual bleeding. These structural changes include:

Uterine fibroids

Endometrial polyps


Your gynecologist will likely order one or both of the following types of pelvic ultrasounds:

Transvaginal ultrasound

Saline infusion Sono hysterography

What’s next?

Your gynecologist might also suggest an endometrial biopsy as part of the diagnostic evaluation.

Based on the results of your history, physical exam and additional testing your gynecologist will be able to establish if you have an underlying cause of your abnormal uterine bleeding. She will recommend treatment options for the underlying cause. Sometimes all of the diagnostic testing is normal and no underlying cause is found. This is actually fairly common in women with ovulatory abnormal uterine bleeding. But don’t worry; just because there isn’t an underlying condition to treat like polyps or thyroid disease there are treatment options that your gynecologist will discuss with you.

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