Heavy Periods and How We Evaluate Them

Many teens, women over 45 and those with PCOS, are more likely to have a new onset of heavy bleeding. This is often caused by an imbalance of the 2 hormones that regulate the menstrual cycle, estrogen and progesterone.

Many times, it’s caused by a lack of ovulation. When that happens, the lining of the uterus, known as the (endometrium) may grow too much and a woman may experience heavy and prolonged bleeding. Check in with your health care provider if:

• You have been bleeding for more than 10 days in a row
• You are soaking through a pad and/or a tampon in less than 1 hour for more than 3-4 hours
• Your periods come more often than every 21 days
• You’ve gone through menopause and suddenly have started bleeding again

Tests you may have

TSH – The Thyroid Stimulating Hormone as the thyroid impacts our menstrual cycles

Prolactin – A pituitary hormone that helps with lactation and can interfere with periods.

Von Willebrand’s factor – For teens or any woman with a long history of heavy bleeding it’s important to rule out any bleeding tendencies such as Von Willebrand’s syndrome.

Endometrial biopsy – A thin tube is passed into the uterus to obtain a sample of the lining of the uterus (endometrium). This sample is sent to a pathologist to determine if there are any abnormal cells present. 

Other Tests

When abnormal or heavy bleeding occurs, it’s often recommended that you have one or more of the following:

• An ultrasound to determine the cause of the bleeding and to measure the width of the lining of the uterus (endometrium)
• Sonohysterography – In this type of ultrasound, a small amount of fluid is inserted into the uterus to separate the sides to look more carefully at what might be causing the bleeding, such as fibroids, polyps or other abnormalities, and
• Hysteroscopy – This can be done in an office setting using Endosee, which is comprised of a thin tube that is attached to a smartphone like device to directly visualize the inside of the uterus. 

Many women are hesitant to have their heavy bleeding evaluated because they’re too busy and figure it will go away. Others are hesitant to see a provider for fear that the only treatment will be surgery. Let me reassure you that there are many non-surgical treatments that are safe and effective. Don’t let fear prevent you from being evaluated.

Unfortunately, many women become anemic from month after month of heavy periods, when there are simple, safe and effective treatments available.