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“Normal” Versus Heavy Menstrual Bleeding
When does menstrual bleeding stop being “normal” and start being considered heavy? Doctors often use the following examples as signs of heavy bleeding: bleeding that lasts more than seven days, bleeding that soaks through one or more tampons or pads every hour for several hours in a row, bleeding that requires wearing more than one pad at a time to control menstrual flow, among others.1,2 On average, women normally lose about 25 to 45 milliliters (mL) of blood during their periods, while women with menstrual bleeding that’s considered “heavy” can experience a blood loss of twice that amount, and in some cases, more than 80 mL per cycle.3-5 It’s important to know that heavy menstrual bleeding is not considered part of a “normal period” and may be a sign of a more serious health problem, like uterine fibroids.1,6
Understanding Uterine Fibroids
Uterine fibroids, also called leiomyomas, are estrogen and progesterone-dependent, non-cancerous tumors of the uterus.6 There are approximately six million women in the U.S. living with symptomatic uterine fibroids.7,8 In fact, they are the most common benign tumor in women of reproductive age and can occur in nearly 70 percent of Caucasian women and more than 80 percent of African American women by age 50, though it is unclear how many of these women will experience uterine fibroid symptoms.9-12
Some women with uterine fibroids can experience a variety of symptoms — including heavy menstrual bleeding, painful periods and prolonged and/or frequent bleeding — while others may have no symptoms.10,11,13 Uterine fibroid-associated symptoms can also affect women’s work, family and social activities.14
Understanding Treatment Options for Uterine Fibroids
If you have uterine fibroids, but do not experience any symptoms, treatment may not be necessary. However, if you have symptoms, there are options available to you.
“For women that require treatment, it’s important to have an open conversation with your healthcare provider,” said Dr. Veronica Gillispie-Bell, MD, FACOG. “You should discuss your symptoms and their effect on your lifestyle. Medical management and surgical options are available, and treatment plans should be tailored to meet each patients’ individual needs.”
Here are the types of treatments that may be considered to help with uterine fibroid symptoms:
Medical management is available to address symptoms such as heavy menstrual bleeding and pelvic pain.10,13 While pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may be effective in alleviating pain related to fibroids, other options typically work by targeting hormones that regulate the menstrual cycle.13 These medications include: 6,10,13,15,16
- Gonadotropin-releasing hormone (GnRH) antagonists work by blocking GnRH receptors in the pituitary gland, which helps lower the production of estrogen in the body. This may lead to the reduction of heavy menstrual bleeding.
- Hormonal birth control may help manage the symptoms of uterine fibroids. These medications can be administered in different forms, including low dose birth control pills (includes estrogen/progestin pills and progestin-only pills), hormonal IUDs (intrauterine devices), progestin injection and implants.
- GnRH agonists work by suppressing the production of estrogen and progesterone.
Both minimally invasive procedures and traditional surgeries (such as hysterectomy) may also be considered for uterine fibroid-associated symptoms. Surgical options include: 6,10,13,15
- Uterine fibroid embolization or uterine artery embolization is a procedure in which tiny plastic or gel particles are injected into the blood vessels connected to fibroids to shrink them by cutting off their blood flow.
- Endometrial ablation is performed with a laser, wire loops, boiling water, and other methods to remove or destroy the lining of the uterus to help control heavy menstrual bleeding.
- Myomectomy is used to only remove uterine fibroids, and may be performed via an abdominal incision, hysteroscopic or laparoscopic procedure depending on the size and location of the fibroids.
- Hysterectomy is the surgical removal of the uterus and is currently the only cure for uterine fibroids. A doctor may recommend a hysterectomy if the fibroids are large or symptoms have not been controlled by a less-invasive treatment option. Uterine fibroids are the leading reason for hysterectomies performed in the U.S.
Before making your decision on a treatment plan for uterine fibroids, it’s important to talk to your doctor about your specific symptoms, lifestyle and treatment goals.
For more information on understanding uterine fibroids, how to talk to a doctor about heavy menstrual bleeding and treatment options visit www.TalkFibroids.com.
1. ACOG. Heavy Menstrual Bleeding. https://www.acog.org/Patients/FAQs/Heavy-Menstrual-Bleeding. Accessed June 2020.
2. Centers for Disease Control and Prevention. Heavy Menstrual Bleeding. https://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html. Accessed June 2020.
3. WomensHealth.gov. Your menstrual cycle. https://www.womenshealth.gov/menstrualcycle/your-menstrual-cycle#3. Accessed June 2020.
4. Bulun S. Physiology and pathology of the female reproductive axis. Williams Textbook. Chapter 17;590-663.
5. Apgar BS, Kaufman AH, George-Nwogu U, Kittendorf A. Treatment of menorrhagia. Am Fam Physician. 2007 Jun 15;75(12):1813-9.
6. WomensHealth.gov. Uterine Fibroids. https://www.womenshealth.gov/a-z-topics/uterine-fibroids. Accessed June 2020.
7. Fuldeore MJ, Soliman AM. Patient-reported prevalence and symptomatic burden of uterine fibroids among women in the United States: findings from a cross-sectional survey analysis. Int J Womens Health. 2017;9:403-411.
8. United States Census Bureau website. American Community Survey (ACS) 2017 1-Year Estimates Subject Tables.
9. Baird D et al. High cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence. Am J Obstet Gynecol. 2003;188:100-107.
10. De La Cruz MS et al. Uterine Fibroids: Diagnosis and Treatment. Am Fam Physician. 2017;95(2):100-107.
11. Khan A et al. Uterine fibroids: current perspectives. Int J Women’s Health. 2014;6:95-114.
12. Wallach EE, Vlahos NF. Uterine myomas: an overview of development, clinical features, and management. Obstet Gynecol. 2004;104:393–406.
13. ACOG. Uterine Fibroids. https://www.acog.org/patient-resources/faqs/gynecologic-problems/uterine-fibroids. Accessed June 2020.
14. Borah BJ, Nicholson WK, Bradley L, Stewart EA. The impact of uterine leiomyomas: a national survey of affected women. Am J Obstet Gynecol. 2013;209(4): 319.e1–319.e20.
15. Mayo Clinic. Uterine Fibroids. https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/diagnosis-treatment/drc-20354294. Accessed June 2020.
16. Schlaff et al. Elagolix for Heavy Menstrual Bleeding. NEJM. January 2020; 382(4):328.