Heavy Periods Are Important to Discuss

Extreme bleeding can cause iron deficiency, chronic anemia and fatigue. It can even cause issues with mental health and cognition

By Deborah Jeanne Sergeant

Women with abnormally heavy and painful menstruation should not ignore the issue.

Most women experience a period that lasts two to seven days and expel two to three tablespoons of blood over that timeframe. Minimal cramping or managing cramping with over-the-counter medication is normal. However, extremely painful, debilitating cramps are not. The latter can cause women to take sick leave.

For example, extreme bleeding can cause iron deficiency or chronic anemia. Women may experience chronic fatigue. It can even cause issues with mental health and cognition.

Many women delay seeking help for heavy periods. If it’s minimized, they may think they’re “being wimps” for speaking up and asking for help from their healthcare providers.

“Sometimes, it can be embarrassing for women to discuss the amount of bleeding or how much it’s affecting their quality of life,” said Keila Muniz, urogynecologist with St.

Joseph’s Health. “It can be difficult to get into see a clinician, depending on availability, office wait times and insurance coverage. Some patients have a fear of what the pelvic exam actually entails, especially if they’ve had a prior negative exam or history of abuse. The other thing is that sometimes unfortunately, a heavy bleeding episode can indicate a pregnancy or pregnancy loss.

“It’s something that patients need to come to terms with. It’s important for patients to advocate for themselves and if they get resistance, they need to insist they see a specialist who can help them with menstrual issues.” rience nausea and gastrointestinal upset. The medication should be a “tier 2” medication, indicating that most insurance will cover it with a moderate co-pay for patients. But if it is out-of-pocket, it could cost up to $600 per month. Driscoll said that would be a barrier for many women.

Many women may also fear a diagnosis of uterine or cervical cancer or a disease in their reproductive system. But Muniz said that it’s more likely that the cause is a benign polyp, uterine fibroids, trauma or an injury or fall.

The thought of various treatments may prevent them from seeking help. However, Muniz said that treatment may include medication, surgery or other interventions.

Keila Muniz, urogynecologist with St. Joseph’s Health, said that she offers menopausal patients numerous strategies for dealing with hot flashes, including using air conditioning and fans and dressing in layers to tame the heat. Some non-hormonal medication may help, like selective serotonin reuptake inhibitors.

“These are used for depression but in low doses are good for just hot flashes,” Muniz said. “It’s a pleasant surprise when patients say that they didn’t know that would help.”

SSRI medication offers dual use. The North American Menopausal Society states on its website that women going through menopause are especially prone to depression and that they experience double the rate of depression of younger women.

“We have non-hormonal medication, hormonal medication and more,” said Michelle Chin, physician with Rochester Regional Health.

As to which is appropriate depends upon other health factors and the patient’s preference.

Heavy periods do not often indicate a serious issue. In fact, “most likely, there’s nothing seriously wrong and there’s a treatment that can give them relief,” said Carol Peterson, physician and assistant professor at URMC.

“It’s important to pay attention to this because most of us don’t have lifestyles that can sustain four to five days of cramps and misery,” she added.

Very heavy periods could also indicate fibroids, endometriosis or cancer. Even these more serious diagnoses can potentially be treated. But the first step is to seek help from a provider.

“Talk with your doctor and figure out what’s going on,” Peterson said. “You can take medication that help decrease the flow. We have a lot of ways to treat heavy periods. You may have a form of hemophilia, which is treated in a different way. Some just have very heavy periods but can be treated.”

For very heavy bleeding, tampons and pads may need changing more than is convenient. Washable period underwear can also provide an additional barrier of protection against leaks.

Menstrual cups and disks require less frequent attention and are reusable, saving money and landfill space. Using a cup can also help women know exactly how much they’re bleeding as some cups include measuring marks. This information can be helpful when talking with a healthcare provider.

Women should discuss with their healthcare provider how to address heavy periods and how treatments relate to their other health concerns and any medications.