Do you wonder if you have abnormally heavy periods?

Take the Quiz

• Are you changing your pad or tampon every 1-2 hours for the first 1-2 days?

• Are you bleeding for more than 7 days?

• Are your periods showing up less than 20 days apart?

If you answered yes to any of these questions, you might be like the other 1.4 million women in the US who are experiencing excessive, heavy menstrual bleeding, known as Abnormal Uterine Bleeding (AUB).

This is disruptive

As you can imagine,  over half of women with heavy menstrual bleeding report that their periods interfere with their lives compared to women with lighter cycles.

Jane* skipped her daughter’s weekend soccer games because she couldn’t count on finding a clean bathroom in case she needed to change her protection.

Melanie was tired of ruining sheets and her mattress from heavy nighttime flow, so resorted to slipping a plastic sheet over her mattress, which made a lot of rustling noises that kept her awake.

Abby was afraid to discuss her bleeding with her health care providers for fear that the only remedy would be a hysterectomy.

Definition of Heavy Bleeding

The American Congress of Obstetricians and Gynecologists (ACOG) defines Abnormal Uterine Bleeding this way:

• Bleeding that soaks through a pad or tampon in less than 1-2 hours for 1-2 days

• Bleeding that comes more frequently than every 20 days

• Bleeding that lasts for more than 10 days

• Bleeding in excess of 80 cc a month – a super tampon or pad can hold approximately 10 cc of blood- that’s only 8 tampons per cycle

• Bleeding that causes anemia

• Bleeding that leads to disruption in life style

Source: ACOG, Committee Opinion. April 2013 (reaffirmed 2015), number 557.

A Woman’s Normal Anatomy 

A woman’s normal reproductive anatomy

Midlife women

If you’re 45 or a little older and your periods haven’t stopped completely, there’s a 50/50 chance that you will experience abnormal bleeding. The most common reasons are:

• Polyps

• Fibroids

• Adenomyosis

• Skipping ovulation

• Pre-cancerous or cancerous condition

Structural causes of heavy bleeding

Polyps and fibroids can cause heavy periods

PALM – COEIN

When women seek help for abnormal bleeding, providers can now use a new terminology, PALM – COEIN, which was agreed upon by the International Federation of Gynecology and Obstetrics (FIGO). PALM – COEIN uses an acronym to classify and separate the causes of AUB into structural and non-structural etiologies.

The PALM-COEIN terminology helps women’s health providers as they consider the differential diagnoses and treatment options based on the specific etiology.

PALM – Structural causes of AUB

P – Polyp

A – Adenomyosis

L – Leiomyoma (fibroids)

M – Malignancy/Hyperplasia

COEIN – Non-structural

C – Coagulopathy

O – Ovulatory

E – Endometrial

I – Iatrogenic

N –Not Classified

Source: Established by FIGO – Fédération Internationale de Gynécologie et d’Obstétrique (the International Federation of Gynecology and Obstetrics)

How do we diagnose?

When evaluating women with bleeding, one test that’s often overlooked especially in women over 40, is a quantitative pregnancy test, which is what is also available over the counter. Pregnancy is one of the most common causes of bleeding in women of reproductive age. Once it’s determined that the woman isn’t pregnant, it’s important for providers to evaluate for structural causes utilizing ultrasound, hysteroscopy, Endosee® and other imaging.

Ultrasound is used to look for any causes of heavy periods

In addition, women who have abnormal bleeding may need to have an endometrial biopsy to make sure there isn’t any abnormal cell growth.

Don’t let fear prevent you from being evaluated

If you or someone you care about has heavy periods, don’t let the fear of hysterectomy prevent you from getting an evaluation so that you can understand the treatment options, many of which don’t involve any surgery. Some of the options are

• Medications

• Oral Contraceptives

• IUDs

• Minimally invasive Polyp and Fibroid removal