In the developed world, girls now get their periods earlier, and women spend less time being pregnant and breast feeding on demand. This means that the average women can now expect to have more than 400 menstrual cycles in her lifetime (ESHRE, 2007). Even the use of most hormonal contraceptives (pill/patch/ring) will yield a monthly bleed. So it’s no wonder that women are so concerned when their cycles seem to be longer and heavier than usual.
To address the most-pressing question, “When should I be concerned? What is the medical definition of too much bleeding?” there is a medical definition of “too-heavy periods.” If a woman is bleeding 80cc (2.7 ounces — about 1/3 of a cup) or more, that is excessive bleeding. Trying to measure exactly the amount of bleeding is difficult even in a research setting, much less in a home bathroom! Some general indications of excessive bleeding can include:
* Saturating a maxipad or super tampon every 60-90 minutes for several hours.
* Passage of large clots (quarter-sized or larger).
* Significant bleeding for more than seven days.
Probably the most important factor would be if your bleeding is heavy enough to interfere with your normal activities.
So if your bleeds are too heavy, read on for some possible explanations.
Hormonal causes are usually linked to missed or erratic ovulation. As you may know, in a normal cycle, estrogen is produced all month. Estrogen is responsible for building up the lining of your uterus so you have something to shed each month. In a normal cycle, progesterone production increases following ovulation. Progesterone “stabilizes” the uterine lining in preparation for a possible implantation of a new pregnancy. If you are not pregnant that month, the levels of estrogen and progesterone fall, triggering the release of the uterine lining — your period.
So if you do not ovulate, the estrogen build up of the lining continues, but without the usual ovulation-associated progesterone. Thus, the hormone levels don’t decline, and the lining stays up inside the uterus as a missed/late period. Alternatively the lining can begin to shed under its own weight, producing prolonged bleeding. After several months of missed periods, the lining of the uterus can become very thickened. Prolonged and heavy flows are not uncommon after months of missed flows.
There are MANY causes for not ovulating including low thyroid, a benign pituitary growth (“adenoma”), or a problem with the hypothalamus. All of the stress-related causes of not ovulating (e.g., sudden increases in exercise, crash dieting, problems with relationships, financial worries, etc.) can be linked to the effects of stress hormones from the brain on the hypothalamus. Increased body weight may trigger hormone changes leading to polycystic ovarian syndrome (PCOS). A transient ovarian cyst can halt ovulation for a time.
There are treatments for each of the causes of heavy bleeding we have discussed. So if you or someone you know have episodes of heavy blood loss rather than a normal period, talk to your doctor because there are ways to stop going with the flow.
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