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Common Abnormalities of Menstrual Flow

While menstruation is a normal monthly event for most women, many women suffer from common symptoms or consequences of menses without knowing that treatment is available.  While these symptoms are common, many of them are not normal.  How would you know if your symptoms need medical attention? Many menstrual symptoms are easily self-treated. However, any symptoms that disrupt your activities of daily living or which interfere with your interpersonal relationships warrant a visit to your gynecologist along with a complete medical evaluation. Menstrual blood loss is one of the factors which may cause medical consequences. The average blood loss during a normal menstrual period is about 50 milliliters, with a range of 20 to 80 ml. This is equivalent to 10 teaspoons or 1.7 ounces of blood lost. While this seems like a small amount, iron deficiency anemia (IDA) is one of the most common consequences of menstruation. About 20% of women and 50% of pregnant women (compared to 3% of men) have IDA. Because of regular monthly menstrual blood loss, women have higher daily dietary requirements for iron than men do; women with a heavier monthly flow (menorrhagia or hypermenorrhea) are at greater risk for developing IDA. While IDA is usually easily treated with iron supplements, it is often overlooked. There are a wide variety of symptoms associated with IDA, but the most common include fatigue, weakness, pale skin color, irritability, dizziness, and headaches. Some unusual symptoms include brittle nails (sometimes with a concave shape), decreased appetite (especially in children), or cravings for ice or unusual non-food substances like clay or chalk (this is called pica). Women with heavier periods are at much greater risk for IDA. What causes heavier periods? Fibroids, or non-cancerous tumors of the uterus, are the most likely suspect. Also known as myomas or leiomyomas, these are simply estrogen-dependent overgrowths of uterine smooth muscle cells. Fibroids are extremely common, affecting one in four to one in five women. Fibroids increase throughout a woman's pre-menopausal years, affecting 2 out of every 5 women in their 40's. The good news is that fibroids generally shrink after menopause. While many women with IDA as a result of fibroids can be treated successfully with conservative therapies, fibroids are still the number one reason for hysterectomy. Women with heavy periods should not jump to conclusions that they will necessarily need a hysterectomy as a result however. Several minimally invasive techniques are now available to treat women with fibroids. 

Another cause of heavy or prolonged periods (metrorrhagia or meno-metrorrhagia) is called dysfunctional uterine bleeding (DUB). DUB includes hormonally-caused bleeding abnormalities (typically anovulation) or bleeding disorders. These bleeding abnormalities require medical attention.

How do you know if the amount of your menstrual flow is normal? A normal menstrual flow is heaviest on the first 2 days, then tapers off gradually in less than seven days. The color varies from bright red to dark brown, representing the transition from new blood to older blood.  Small clots are normal. These indicate that the blood had time to pool and clot before being expelled. Larger clots may indicate a much larger volume of blood.  Having to change your tampons or pads much more frequently may also indicate a larger blood loss than usual.  Soaking through an absorbent pad or tampon within an hour, for example, would indicate heavy bleeding that should be evaluated.

Created: 6/20/2005  -  Donnica Moore, M.D.

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