What You Should Know About Abnormal Uterine Bleeding

At least once during their reproductive years, most women experience bouts of heavy bleeding when they have their period, or menorrhagia. The most common times are during the first few years of menstruation, and then again during the final two to three years before menopause.

Heavy period blood can be especially alarming if it contains clots. In most cases, though, red, brown, or even black menstrual blood clots are normal—just bits of the endometrium (the lining of the uterus) that are shed during menstruation.

But there are times when menorrhagia is a sign of a problem. Here's what you should know about abnormal uterine bleeding and clotting, including what may be causing the heavy flow and how it can be treated.

A pile of tampons on a table
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Symptoms

What's considered heavy bleeding during menstruation? If you're finding you need to change your pad or tampon more often than every hour or so, or if you're having a period that's been going on for seven days or more, then you may be experiencing abnormal bleeding.

Unless you're pregnant when you experience abnormal uterine bleeding, a single episode of heavy menstrual bleeding usually doesn't require treatment. One exception is if the heavy bleeding lasts for more than 24 hours, in which case you should get in touch with your doctor as soon as possible.

Causes

Usually, a hormonal imbalance is to blame for abnormal uterine bleeding. Other causes include:

People who use an intrauterine devices (IUD) also sometimes have excessive or prolonged periods. If you experience excessive uterine bleeding while using an IUD, it should be removed and you should try another birth control method.

Disorders of the platelets, such as von Willebrand's disease, are the most common blood disorders of excessive menstrual bleeding. These usually are diagnosed soon after a young person starts getting their periods.

Adults who have von Willebrand's disease commonly will experience not only heavy menstrual bleeding, but also nosebleeds, easy bruising, and blood in the stool.

Diagnosis

The first thing your healthcare provider will do in order to figure out what's causing you to have heavy menstrual bleeding is perform a pelvic exam, including a Pap smear, lab tests and, if appropriate, a pregnancy test.

The healthcare provider also may order an ultrasound to check for abnormalities such as fibroids or do an endometrial biopsy, dilation and curettage (D&C), or hysteroscopy to further evaluate the condition of your uterus.

If you experience menorrhagia on a regular basis, you should be monitored closely to make sure your iron levels don't dip. If that happens, you may need to take iron supplements.

Treatment

Often, severe bleeding can be treated with a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen and naproxen. These drugs can help reduce bleeding, in addition to easing the pain of menstrual cramps.

If it turns out you have fibroids or another condition, your doctor will treat it appropriately. When a hormonal imbalance is a problem, bleeding can be controlled with progesterone or a combination of progesterone and estrogen, often in the form of an oral contraceptive.

Endometrial ablation, once commonly used to treat excessive bleeding in people past child-bearing age who wanted to avoid hysterectomy, has now been replaced by a therapy called thermal balloon ablation.

In most cases, thermal balloon ablation ends bleeding by destroying the lining of the uterus. Therefore, it's only appropriate for people who are through having children or are certain they don't want them.

However, this procedure does not guarantee 100% protection from pregnancy. People who do not desire children should continue using their preferred birth control method.

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