Experiencing heavy periods is a common cause of iron deficiency anemia, leading to:
- Decreased energy levels
- Difficulty concentrating
- Overall exhaustion
Often, the problem of profuse menstrual bleeding begins during adolescence with menarche (the first menstruation) and can persist throughout a woman’s reproductive years, significantly impacting her health and quality of life. There are even cases where heavy bleeding may start after the age of 30.
Excessive menstrual bleeding can be associated with gynecological conditions and disorders, posing a significant challenge to a woman’s well-being. Unfortunately, it is often underdiagnosed, inadequately treated, and left unresolved. That is why discussing this issue with a gynecologist is crucial.
When Does Bleeding Become Excessive?
A profuse menstrual cycle refers to blood loss exceeding 80 ml per cycle, equivalent to approximately 16-20 thoroughly soaked internal tampons, or when the menstrual period lasts more than seven days and involves the presence of blood clots.
In such cases, it is essential to consult a gynecologist to assess the impact on blood iron levels and investigate any underlying pathology contributing to the heavy bleeding. An early diagnosis enables the initiation of appropriate therapy, leading to resolution of the issue.
Moreover, addressing the root cause of excessive bleeding can alleviate:
- Menstrual pain (dysmenorrhea)
- Chronic fatigue
- Difficulty concentrating due to iron deficiency anemia,
Finally, understanding the nature of the issue can help support women in participating in high-performance sports or experiencing a peaceful pregnancy and postpartum period.
Excessive Menstrual Bleeding: Causes
The causes of heavy menstrual bleeding vary, as do their effects on iron and red blood cell levels. In young women, abundant cycles can be attributed to hormonal changes that disrupt the balance between estrogen and progesterone production. In rare cases, a platelet disorder affecting the clotting function of platelets may also be responsible.
Furthermore, excessive bleeding can lead to reduced levels of:
- Ferritin, which represents iron stores
- Transferrin, which transports iron into cells
- Sideremia, the iron present in the blood
- Hemoglobin, which carries oxygen to various tissues – including the brain
Additionally, with profuse bleeding and iron-deficiency anemia, the red blood cells responsible for delivering nutrients to every organ may become smaller and decrease in number.
In adulthood, there is often a tendency for heavier menstrual cycles. This may be associated not only with hormonal imbalances but also with conditions such as:
- Uterine fibroids
- Endometrial hyperplasia
Abundant Menstrual Cycles: Recommended Tests
In addition to a blood test – which helps determine sideremia, ferritin, transferrin, and complete blood count (CBC) – a gynecological examination, including a pap smear, is crucial for evaluating the presence of:
- Cervical polyps
- Significant cervical lesions, like intraepithelial
- Micro-invasive neoplasms caused by the Human Papillomavirus (HPV)
Furthermore, an abdominal or transvaginal pelvic ultrasound may be conducted alongside the gynecological examination to diagnose and assess submucosal fibroids beneath the endometrium. If polyps, hyperplasia, or submucosal fibroids are detected, the gynecologist will determine whether additional second-level tests, such as diagnostic and interventional hysteroscopy for removal, are necessary.
Treating Anemia Caused by Profuse Menstrual Bleeding
Recognizing and diagnosing the underlying causes of profuse menstrual bleeding is crucial, and seeking assistance from specialists who employ a multidisciplinary approach is highly recommended. The experts can thoroughly assess and treat the predisposing factors and guide the woman throughout the treatment process.
The multidisciplinary approach involves various treatment options. Medical therapy may include:
- Progestin (hormone) drugs
- Administered orally in tablet form or through a medicated intrauterine device (IUD) directly placed in the uterus
- Contraceptive pills, patches, or vaginal rings
- Without the withdrawal period
In cases where the cause of excessive bleeding is due to conditions like endometrial polyps, submucosal fibroids, or endometrial hyperplasia, surgical therapy in the form of hysteroscopic removal can be considered.
Once the underlying cause has been identified, specific treatment can be initiated. In many cases, women may be prescribed supplements of:
- B vitamins (such as folic acid and B12)
- Vitamin C
- A protein that aids in absorption
In situations where severe anemia is present, healthcare professionals may initially administer intravenous iron therapy followed by oral iron supplementation.