For most women, the approximately four decade time span during which they menstruate each month, the experience is — if perhaps a bit of a nuisance — a relatively uneventful feature of the reproductive years. Mild cramps or pre-menstrual syndrome symptoms are fairly common, but these are usually short in duration, easily treated, and not debilitating. Some women, however, experience the challenge of menorrhagia, the medical term for heavy or prolonged bleeding during their periods. For individuals in this group, the monthly menstrual cycle is much more than a nuisance.

“Some women won’t even leave home on heavy flow days because they’re soaking through their protection,” said Cortez gynecologist Daniel Bohle, MD. If a woman is missing work, feeling the need to always be near a bathroom, unable to participate in exercise or social activities, or otherwise burdened by heavy bleeding, she should consider seeing her doctor to investigate treatment options.

A normal menstrual cycle lasts from a few to three to five days. According to Bohle, if a woman’s period routinely lasts more than six days, it may be cause for concern. Interestingly, blood loss during a menstrual cycle is quite small — only 2 to 3 tablespoons on average. “Menses is usually a lot of fluid but not a lot of actual blood,” said Bohle. Losing six or more tablespoons of blood on a monthly basis can become problematic. “A woman can end up with anemia if heavy bleeding is a regular occurrence,” said Bohle.

The causes and treatments for heavy menstrual bleeding vary depending on a woman’s age. “It’s not unusual for teenagers to have irregular periods during the first year or two that they menstruate,” said Bohle. Because ovulation during this phase is unpredictable, younger women may experience heavy bleeding on occasion. “These patients sometimes don’t want to go to the doctor because they’re concerned about getting a pelvic examination,” said Bohle. This type of exam is often not necessary, however, as the causes for heavy flow and cramping can be diagnosed based on the patient’s oral history. One treatment that is often helpful in young women is a low-dose birth control pill which regulates the cycle. Heavy bleeding during the teen years is rarely indicative of a serious problem and reassurance is frequently the only treatment that is needed.

Heavy menstrual bleeding in women in their 20s, 30s, and 40s may have a number of different causes. “Endometrial polyps and fibroids can cause heavy flow,” said Bohle. An examination and biopsy performed in the doctor’s office can usually provide a diagnosis in these cases. An ultrasound may be recommended to determine if a woman has an abnormally thick uterine lining or polyps. Other causes for heavy bleeding and irregular cycles can include a benign pituitary tumor or an underactive thyroid, according to Bohle.

“During the reproductive years we can treat heavy bleeding with hormone therapy,” said Bohle. This might be accomplished with birth control pills or a hormone-releasing IUD, assuming a women is not trying to become pregnant.

As recently as a couple of decades ago, hysterectomy (removal of the uterus and sometimes the ovaries) was routinely recommended for women with abnormally heavy menstrual bleeding. But with newer treatment options that are now available, hysterectomy rates have declined dramatically. A procedure called ablation has become the preferred method for treating heavy bleeding in women who do not respond to other medical treatments. Ablation has been around for more than 20 years in a variety of forms and is intended to intentionally vaporize the lining of the uterus. Following an ablation procedure, about 60 to 70 percent of women cease having menstrual periods altogether. The remainder have periods that are less difficult, both physically and socially.

“Endometrial ablation is a same-day procedure. I usually do them on Fridays and women are back at work on Monday,” said Bohle. Some gynecologists perform this operation in their offices, but Bohle said both he and patients usually prefer the comfort of the hospital setting. The procedure takes only a few minutes, but because the cervix must be dilated in order to perform it, patients are placed under light anesthesia so that they do not experience pain. Complications associated with the procedure are rare. Bohle uses the NovaSure instrument which is one of the newer ablation technologies because it is both effective and has built-in measuring and safety features that reduce the possibility of the uterine wall being punctured during the procedure. Infections associated with ablation are very rare because all patients get a dose of IV antibiotics as they are undergoing the procedure.

Hysterectomy is still necessary for some women who have heavy or prolonged periods, said Bohle. “Adenomyosis, a condition in which the endometrium grows deep into the muscle of the uterine cavity, may not respond to ablation,” he said.

Whatever the cause of heavy menstrual bleeding, women should know that if the problem interferes with their ability to go about their normal routine, that safe and effective treatment options are available which can make their monthly cycles manageable once again.



Southwest Health Notes is a public service feature provided by Southwest Memorial Hospital in Cortez, Colorado. The information provided herein is not intended as patient-specific medical advice or as a substitute for consultation with your personal healthcare provider.