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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