Menorrhagia or heavy regular uterine bleeding

One of the most common things that I see women in the office for is heavy periods.  In this blog, I will discuss heavy regular bleeding in women.  There are different possibilities in younger girls with heavy periods and in women with irregular periods.  I won’t address those in today’s blog.  This is another extensive topic, so I will divide it into two segments.

First of all, any heavy regular bleeding is unlikely to be cancer.  Cancer doesn’t cycle normally.  Cancer just bleeds all of the time, or none of the time, or somewhere in between.  But it definitely doesn’t bleed on a regular cycle.

Common causes of regular, or ovulatory, bleeding include an abnormality of the endometrium (lining of the uterus) like a fibroid or a polyp, adenomyosis, thyroid disorders, and even the copper intrauterine device.

Fibroids are smooth muscle tumors of the uterus that are benign.  Up to 80% of women are thought to have fibroids in their lifetime.  They can be very small and inconsequential, or they can be very large and interfere with quality of life.

Endometrial polyps are hypertrophied or thickened endometrial tissue around a vascular core.  They are very common, although less common than fibroids.

Adenomyosis is when the endometrium grows into the muscular wall of the uterus.  The endometrium is supposed to shed every month.  It is not supposed to be found in the deeper muscular layers of the uterus.  This is an abnormal, or ectopic, location of endometrial tissue.  (Therefore, it is similar to endometriosis, which we will discuss at another time).  Typically, patients with adenomyosis will have not only heavy periods, but painful periods as well.

Thyroid disorders are also common in women, especially in those over 40 or women with a family history.  The thyroid is a gland that sits in the neck, but its abnormal function can affect many organ systems including the reproductive organs.  This diagnosis can be made by a simple blood test.

The copper IUD is a wonderful hormone-free option for contraception, but it is a foreign body placed inside of the uterus.  This causes inflammation of the endometrium, which can lead to heavier menstrual cycles in some women.

In my next blog, I will discuss treatment options for heavy, regular periods.