Understanding Abnormal Menstruation, When to Seek Help

Know the causes of abnormal mestruation. -File Photo

By Adolescent Medicine Specialist, Dr. Elizabeth Alderman and Pediatric Hematologist, Dr. Jennifer Davila 

Manhattan Voice 

July 24, 2023

HEALTH - Most people with the potential to have periods, or menstrual bleeding, generally get their first period between the ages of 10 and 15 years of age. Periods usually come every three to six weeks and may last up to seven days. Sometimes, periods do not become regular until two to three years after the first period. 

 

What is considered heavy menstrual bleeding? 

A normal length for a menstrual period could be up to seven days. In terms of how much bleeding is too much, it’s generally a little more than five tablespoons over the course of the period. If a person who menstruates needs to change a pad or tampon every hour for more than every one to two hours, due to excessive bleeding, then that’s too much. 

Passing blood clots more than the size of a quarter could also be a sign of a heavy period. If periods interfere with going to school, engaging in normal daily activities, or impacts on any aspect of quality of life, that also could indicate that someone has heavy periods.  

Other signs of heavy menstrual bleeding (HMB) include fatigue, low exercise tolerance, paleness, feeling lightheaded or faint. 

What causes heavy menstrual bleeding? 

There are numerous causes of HMB in adolescents. Almost all are medical causes. These include conditions such as thyroid disease, high body mass index and other causes that disrupt the normal ovulatory cycle such as polycystic ovary syndrome. In fact, people who just started menstruating in the past two to three years may have irregular periods, including heavy, prolonged menstrual bleeding due to lack of maturation of the ovulatory cycles. 

Hematologic causes include von Willebrand disease, platelet disorders or low clotting factors which affects the way the body makes blood clots. Rarer causes in adolescents include structural abnormalities that include uterine fibroids, polyps of the cervix, or tumors of the uterus, cervix or vagina. 

Although they do not usually cause HMB, sexually transmitted infections such as gonorrhea, chlamydia, herpes or human papilloma virus, can cause unexpected vaginal bleeding. There are complications of pregnancy that can cause HMB such as ectopic pregnancy, miscarriage and abruption of the placenta, so pregnancy testing is necessary when someone is evaluated for heavy vaginal bleeding. 

What are the complications of heavy menstrual bleeding?

Iron deficiency anemia (IDA) is a common complication of HMB. IDA occurs when there is too little iron in the body. Because of this, the body doesn’t have the building blocks to make more blood and it cannot replace the blood lost through a period. When this happens, a person can experience fatigue, weakness, and can look pale. It can be so severe that a blood transfusion is necessary. 

How are the complications of heavy menstrual bleeding treated?

The best treatment for HMB is identifying the cause. For some adolescents, HMB is caused by a hormonal imbalance, therefore, using hormone therapy in the form of oral contraception or an intrauterine device (IUD) for example, may be treatment options. For others, the cause of HMB may be a bleeding disorder. Bleeding disorders (BD) are a group of conditions where the body’s ability to clot blood is affected. Some people are diagnosed with a BD early in life, while others aren’t diagnosed until they start having their periods. Because BDs are often passed down from generation to generation, a menstruating person may think that having a heavy period is normal because everyone in their family has a heavy period. However, this may indicate that the person has an undiagnosed bleeding disorder and should seek assessment by a hematologist. Treating HMB in a patient with a bleeding disorder includes hormone therapy, antifibrinolytics and if severe enough, replacement of the deficient factor.

The Children’s at Montefiore (CHAM) has a Girls and Bleeding (GAB) Practice which is part of a national network of practices that evaluate people who have menstrual concerns. At the GAB practice at CHAM, patients will be evaluated and treated by us. 

For more information on the GAB practice at CHAM, please go to Girls and Bleeding Program (GAB) | The Children's Hospital at Montefiore (cham.org). Appointments can be made by calling 718 741 2450 or 718 741 2342.