Don’t Dismiss Heavy Menstrual Bleeding in Those with Bleeding Disorders
By Sandy Smith
Unusual menstrual bleeding can be easily dismissed in women with bleeding disorders. But it may mask another condition that, if treated, could lead to dramatic improvement in daily living.
Kalinda Woods, MD, OB-GYN at Emory University, presented Coexisting Women’s Health Conditions Saturday, discussing a number of issues that impact women of all ages.
Abnormal uterine bleeding is defined as bleeding more than seven days, at irregular intervals or saturating a pad or tampon within an hour.
During the first few years after menstruation begins, the hypothalamic-pituitary-ovarian axis may not be fully developed, leading to irregular bleeding or heavy periods.
“Within about two years of somebody beginning their menses, we expect that process will be complete. Often we’ll have moms come to us with their pediatric daughters concerned about hormonal modalities. The first step is watchful waiting. We can wait for that brain- ovary connection to mature.â€
Polycystic ovary syndrome (PCOS) is “disorganized bleeding due to a deficiency of progesterone,†Woods said. “Estrogen is allowed to rise. You want estrogen and progesterone to rise and fall together. One of our goals in treating PCOS is to supplement progesterone.â€
PCOS may bring concerns about fertility, with fewer opportunities for ovulation. But there are methods to stimulate ovary production, Woods said, when the person is ready to pursue a pregnancy.
In those with bleeding disorders, PCOS “is very disordered. These patients can become very profoundly anemic because of the heavy disordered bleeding. Bleeding control is a goal.â€
Cervicitis, an inflammation of the cervix, is commonly caused by sexually transmitted infections. Abnormal bleeding is often an early sign of this disorder, Woods said.
Structural issues, such as fibroids and polyps, also can bring heavy bleeding. Fibroids appear during childbearing years and are “quite common,†Woods said. “We think about 80 percent of women have fibroids in the uterus. How they present depends completely on where they are located and how large they are. Fibroids are often asymptomatic, but when they are symptomatic, women with bleeding disorders can get profound bleeding.â€
Polyps are a soft tissue that is estrogen dependent.
Endometriosis is usually characterized by pain, not severe bleeding. “It is a very not-well-understood entity, but very debilitating and worthy of investigation, counseling and treatment. We like to treat it by ovulatory suppression,†Woods said.
While there are many variabilities in unusual bleeding, there is one hard and fast rule, Woods said. “Post-menopausal bleeding is not normal, ever. It’s always something that needs to be worked up, always. When you tell me you haven’t had a period for a year, that’s when we say, ‘Check, you’re done.’ The most common cause of post-menopausal bleeding is uterine polyps or uterine cancer. Whenever someone has post-menopausal bleeding, we have to biopsy the uterine lining.†â–
