Talking Abnormal Heavy Bleeding with Dr. Hawkins

What does it mean to bleed “abnormally”?

“My cycles have always lasted 7 days and I have always worn 2 pads at a time. It’s not unusual for me to go through a 20 pack of pads per cycle.” “I usually pack an extra pair of pants and underwear when I am on my cycle, just in case. White, HA that’s laughable. I would never be caught dead in white. What if I have an accident?” “Can you please excuse me? I need to use the bathroom again.” All of these statements are not “normal”. The clinical definition of “heavy” or abnormal uterine bleeding (AUB) is menstrual bleeding of abnormal quantity, duration, or schedule. So, what is normal? The normal frequency of menses is every 24 to 38 days, occurring at fairly regular intervals, lasting no more than 8 days, with a volume of blood loss between 5 to 80 mL or 5.5 tbsp. for the entire cycle. Unfortunately, many women suffer through abnormal menstrual bleeding because that is the way it has always been. The causes of heavy menses are vast and could be due to a number of anatomical and/or physiological conditions.  The most common causes of AUB in women between 20-50 years of age are fibroids, adenomyosis, and anovulatory bleeding with the latter usually causing irregular timing and flow. After menopause, postmenopausal bleeding (PMB) could be due to polyps, vaginal atrophy, or even cancer. There are a few differences between fibroids and adenomyosis, the more common causes of AUB. Fibroids are benign, smooth muscle tumors that grow from the muscle of the uterus. Adenomyosis is not a discrete anatomical structure but rather the invasion of the endometrial glands lining the inside of the uterus into the muscle of the uterine body. Both can cause heavy bleeding, pain, and excessive bloating during menstruation. Symptoms vary among women. While some women may experience one or more symptoms, others are asymptomatic. Additionally, fibroids can cause “bulk symptoms”, due to the fibroid pressing on other structures in the abdomen. “Bulk symptoms” can include frequency of urination (fibroid pressing on the bladder), constipation or painful bowel movements (fibroid pressing on the colon), and back pain (fibroid growing towards the back). Other symptoms may include leg pain or difficulty walking due to the fibroids impinging on nerves within the pelvis. If left to grow excessively, fibroids can begin to affect major organs, such as the kidneys, without you being aware. Adenomyosis, alone, usually leaves the uterus slightly enlarged and “boggy” or soft like a sponge. It is important to note that sometimes these two abnormalities are sister-friends and can be found together. Having one does not completely exclude the other. Imaging studies can help to identify fibroids, however, it is not always helpful in ruling out adenomyosis. Most physicians begin with ultrasounds, which provides the best look at the female pelvic anatomy. Fibroids are easily seen on abdominal and/or vaginal ultrasound if present. However, the number of fibroids is not always able to be accurately detected. Generally, more fibroids are present than what is initially seen. A magnetic resonance imaging (MRI) may be necessary to get a more accurate look at fibroid anatomy and to better visualize adenomyosis. Unfortunately, MRI imaging can be expensive, especially if it is not needed. Talk to your doctor about your abnormal uterine bleeding and heavy cycles! Come see me, Dr. Hawkins at Fibroid and Pelvic Wellness Center of Georgia, for surgical management and minimally invasive options to manage your fibroids and/or adenomyosis.