Researchers are waking up, but in the meantime, women suffer. A recent newspaper article summed up part of the problem.

A survey by ResearchGate, a social networking site for researchers, of studies on the site found five times more research on erectile dysfunction, which affects 19 per cent of men, than on premenstrual syndrome, which affects 90 per cent of women.

The journey I had may serve as an illustration of medical information neglect. I was taken from a train at Grand Central Station in NYC, hauled off to the downstairs medical office, and scoffed and scolded by a nurse who said I would have to be quiet and lie there. OK, perhaps they had nothing for me in terms of a pill, but a few comforting words might have helped.

I had doubled over on the train, nauseous, unable to walk because of the intense pain, and this was the care I got. Hours later, I would be put on another train to go home alone after they gave me aspirin.

It wouldn’t be the first time the pain had incapacitated me, nor the only time I couldn’t go to work that day because of it. I’d suffer with it despite many visits to various physicians and medical centers. One famous NYC gynecologist insisted she’d only prescribe birth control pills to control the pain — didn’t help, but she refused anything else.

The situation in the professional literature is summed up as follows:

Primary dysmenorrhea, or painful menstruation in the absence of pelvic pathology, is a common, and often debilitating, gynecological condition that affects between 45 and 95% of menstruating women. Despite the high prevalence, dysmenorrhea is often poorly treated, and even disregarded, by health professionals, pain researchers, and the women themselves, who may accept it as a normal part of the menstrual cycle.

Yes, I’ve even had to depend on the kindness of strangers. Once, while at work, the pain and lowering of my blood pressure struck, and I had to go home via subway that time. Of course, to get to my home in my mother’s house, I’d have to change trains, and that was where a kindly Black woman came to my aid.

She saw how I looked and that I couldn’t possibly walk up the two flights of stairs to the next train, so she called my mother and asked her to come to get me. “I’ll stay with you until your mother arrives,” she said, and we sat on a bench together. We didn’t speak but knowing she was there provided more comfort than I had ever received while in this state. My mother came, and the woman left with a wish for me to feel better. I will never forget her.

After the unsatisfying appointment with the NYC OB/GYN (featured in Cosmo, BTW), I tried a major NYC medical center. The physician there told me he would be “your doctor now” and proceeded to put me into a clinical trial and “treat” me with a diuretic medication that lowered my potassium levels. Do you know what that does? It does nothing for menstrual pain, but it brings on a host of other problems instead. I stopped going back to him.

My next venture was to a physician (I can’t remember how I got his name), and he prescribed what turned out to be an addictive, highly effective medication that stopped the pain but increased my activity levels 100-fold and had me sweating profusely. It worked, and I was determined to stick with it until it was taken off the market because of its addictive qualities. Sorry, I can’t remember its name. I know a major NYC corporation’s onsite medical office regularly gave it to female employees.

Years later, I would be told how an aunt of mine had similar pain, and while taking her home, my mother met her future husband, who gave the two women a lift home. Yes, it ran in the family.

Still more years later, I discovered we have a genetic anomaly that may cause the pain as well as migraine, depression, miscarriage and a variety of other ailments. But, a researcher told me I shouldn’t worry because there’s a town in Australia where “half of the population has that genetic signature.” Oh, so comforting to know.

Menstrual Pain Known Causes

The evidence is there that women suffer, and there’s a paucity of research on why they suffer from this pain. But the literature has suggested several areas where some research has shown promise as to its roots in their research. Results of this work’s applicability to most women may be sadly limited.

After ruling out physical problems in adolescent females, such as endometriosis, fibroid tumors or underlying pathology, dysmenorrhea is often treated with NSAIDs, hormonal therapy, lifestyle changes and perhaps complementary medicine. The complementary medicines that are most usually recommended are peppermint, cinnamon, ginger and other herbs and supplements.

If endometriosis is a potential cause of the pain, referral to a gynecologist is recommended. The article, however, has an important caveat that indicates the etiology of primary dysmenorrhea is not completely understood…

The presence of a specific genetic configuration was found to be involved in a sample of women who experienced menstrual pain. Those with this genetic component were three times more likely to have pain than those who did not have the genetic condition. Not only did the condition cause pain, it had major implications for education and careers because of the lost days in school and work as a result of pain.

An investigation of a plethora of 566 articles on menstrual pain found that childhood adversity played a role. Sexual abuse and posttraumatic stress disorder appeared to be associated with dysmenorrhea, pelvic pain, and dyspareunia, but it was unclear whether this relationship was mediated by poorer mental health.

Now, those researchers brought in the factor of mental health. Are they intimating that the females had mental health issues that brought on their pain? Is this more “unconscious conflict” possibly about being female? Sounds like a throwback to me.

We are reminded, however, of the paucity of research (as noted in the ResearchGate investigation) on the subject and question the potential skewing of the pool of subjects for the studies. How many of those studies included a genetic component?

Another study looked at postural stability and menstrual pain. Did women who had this pain have difficulties in this area? It seems they concluded they did, but how would that account for the pain? More research needed and they recommended preventive rehabilitation strategies can be given to improve postural stability. Suppose they had included a genetic evaluation and didn’t concentrate solely on postural stability? Would they have come to a different conclusion?

The jury is still out on this one and there is no question that women deserve better information to provide relief that will benefit every area of their lives.

The post Women Suffer Because of Medical Misinformation About Debilitating Menstrual Pain appeared first on Medika Life.

People are stocking up on hand sanitizer and toilet paper. Tampons and sanitary napkins may be next on the list of products in short supply. If the hoarding continues the coronavirus pandemic may lead to a shortage of feminine products.

An eco-friendly option

Now is a great time to invest in an alternative feminine hygiene product called a menstrual cup. A menstrual cup is a small silicone cup gently placed inside the vagina to contain menstrual blood.

These cost-effective, environmentally friendly cups are growing in popularity. Menstrual cups are safe and reusable. One cup costs around $25–30 and can be used for up to ten years. Despite the higher upfront costs, these reusable cups save money long term. The most popular brands are the Diva Cup manufactured in Canada and the Mooncup manufactured in the UK but now also available in the US.

Patients love their cups!

I admit when I first heard about menstrual cups years ago, I found the idea a bit strange. Patients who use menstrual cups swear by them. My patients sold me on this great option. They plan to never return to traditional feminine products.

How to insert your menstrual cup

1. Wash your hands.
2. Apply a small amount of water or lubricant to the rim of the cup and fold as shown below
3. Insert the cup rim up into the vagina.

If placed correctly, one should not feel the cup inside the vagina. If the cup feels uncomfortable, it may need a slight nudge with your finger to move it up higher in the vagina.

Lubricant is not an absolute necessity, but most patients find it helps to make insertion more comfortable. Rinse the cup off if it is dropped or falls to the floor during insertion. The five-second rule does not apply.

The cup creates a small seal collecting the menstrual blood released from the cervix. The device will pop into the proper location when inserted into the vagina. One does not have to worry about placing it correctly. Unless it is leaking or causing pain, the cup is in the right spot.

The menstrual cup should be removed and cleaned when full. It may be removed and rinsed as often as needed but should not stay in for more than twelve hours.

How to remove your menstrual cup?

1. Wash your hands.
2. Pinch the tip of the cup with your thumb and index finger to release the seal.
3. Remove the cup and dispose of the contents into the toilet.
4. Wash the cup with mild soap and warm water for reinsertion or storage.

Safer for the environment

Menstrual cups are better for our environment than traditional products. They reduce the use of nonbiodegradable feminine pads and tampons. An estimated 20 billion feminine products are used in North America each year. Discarded pads and tampons sit in landfills. The plastic and nonbiodegradable components take up 50 years to degrade.

Safer for you

Both the Mooncup and the Diva Cup are manufactured from medical grade silicon. This means no dangerous chemicals leeching into your body and if you suffer from latex allergies you can still safely use either product.

Skip the lines and try it out

Menstrual cycles are a part of life. As the Coronavirus spreads the supply chain for household products may get worse before it gets better. Avoid the lines at the grocery store. There is no need to stock up on feminine products. Order a menstrual cup and try out this eco-friendly option.

Not sure which one to buy?

Here is a side by side comparison of both products to help you decide which is more suitable.

Color

The Mooncup and the Diva cup are both available in just the one same color – semi-transparent / clear. The lack of pigmentation means that it is easier to thoroughly clean the item; it is easier to see any patches that you may have missed.

When it comes between the Mooncup vs Diva Cup on looks, they’re both very similar in terms of colour and design when placed alongside each other.

Material

Both the Mooncup and Diva Cup are made from the same material. Latex-free and hypoallergenic, each is suitable for people with sensitive skin. They are made from medical standard soft silicone, and do not contain any dyes.

Place of Manufacture

The Mooncup is manufactured in the UK and the Diva Cup is made in Canada.

Sizes

Both the Mooncup and Diva Cup are available in two sizes; small and large.

• The Mooncup size A (large) is recommended for women over the age of 30 who have had a vaginal birth. Size B (small) is for women under the age of 30 who have never given had a vaginal birth.
• The Diva Cup size 1 (small) is recommended for women under the age of 30 who have not given birth vaginally; size 2 (large) is for women over the age of 30 as well as people who have had a vaginal birth.
• The Mooncup has six suction cups, and the Diva Cup has four.

Note that the sizes are the opposite to each other, with Mooncup decreasing in size, and Diva Cup increasing in size.

Dimensions

The smaller Mooncup (size B) has a length of 71 mm and a diameter of 43 mm. The smaller Diva Cup (size 1), is slightly smaller, with a length of 70 mm and a diameter of 41 mm.

Comparing the larger menstrual cups, the Mooncup (size A) has a length of 71 mm and a diameter of 46 mm, whereas the Diva Cup (size 2) has a length of 70 mm and a diameter of 45 mm.

Again, the largest Diva Cup is slightly smaller than the Mooncup.

Capacity

Mooncup size B can hold 28.8 ml, whereas the Mooncup size A has a slightly bigger capacity of 29.3 ml. Both sizes of the DivaCup have a capacity of 30 ml.

Duration of Use

Users are advised to empty and clean the Mooncup every four to eight hours. The Diva Cup says that it can be used for longer, up to a maximum of 10 – 12 hours.

Use with IUDS

Both the Mooncup and Diva Cup state that they can be used with IUD birth control measures. Although, you should stop use and consult a doctor if you have any problems.

So…Which One?

The larger capacity of the Diva Cup might make it more preferable for ladies who have a heavy menstrual flow each month. With a shorter and smoother stem, some females might find it more difficult to remove.

The Mooncup, on the other hand, might be preferred by women who have a lower cervix because of the shorter length. The harder rim, however, may present problems for women who have sensitive bladders. The longer stem can be trimmed if necessary, and there are grips to make removal easier.

Before purchasing your menstrual cup, things to think about include whether you generally have heavy or light periods, whether your cervix is fairly high or low, and how deep and wide your vagina is.

As each type of menstrual cup has been designed to be used by any female, and they are both very similar, your ultimate decision will largely come down to personal preference.

Affiliate Links

Please note this article contains affiliate links to Amazon.

The post MENSTRUAL CUP; Now is the time to try one appeared first on Medika Life.

A day by day guide to the menstrual cycle. If you are planning a pregnancy you may want to use the Ovulation calculator to work out your fertility dates.

Days 1 through 5

Day 1 starts with the first day of your period. The blood and tissue lining the uterus (womb) break down and leave the body. This is your period. For many women, bleeding lasts from 4 to 8 days. Hormone levels are low. Low levels of the hormone estrogen can make you feel depressed or irritable.

During Days 1 through 5 of your cycle, fluid-filled pockets called follicles develop on the ovaries. Each follicle contains an egg

Days 5 through 8

Between Days 5 and 7, just one follicle continues growing while the others stop growing and are absorbed back into the ovary. Levels of the hormone estrogen from the ovaries continue rising. By Day 8 the follicle puts out increasing levels of estrogen and grows larger. Usually by Day 8, period bleeding has stopped. Higher estrogen levels from the follicle make the lining of the uterus grow and thicken. The uterine lining is rich in blood and nutrients and will help nourish the embryo if a pregnancy happens. Estrogen helps boost endorphins, which are the “feel good” brain chemicals that are also released during physical activity. You may have more energy and feel relaxed or calm.

Day 14

A few days before Day 14, your estrogen levels peak and cause a sharp rise in the level of luteinizing hormone (LH). LH causes the mature follicle to burst and release an egg from the ovary, called ovulation, on Day 14. A woman is most likely to get pregnant if she has sex on the day of ovulation or during the three days before ovulation (since the sperm are already in place and ready to fertilize the egg once it is released). A man’s sperm can live for three to five days in a woman’s reproductive organs, and a woman’s egg lives for 12 to 24 hours. In the few days before ovulation, your estrogen levels are at their highest. You may feel best around this time, emotionally and physically.

Days 15 through 24

Over the next week (Days 15 to 24), the fallopian tubes help the newly released egg travel away from the ovary toward the uterus. The ruptured follicle on the ovary makes more of the hormone progesterone, which also helps the uterine lining thicken even more. If a sperm joins with the egg in the fallopian tube (this is called fertilization), the fertilized egg will continue down the fallopian tube and attach to the lining of the uterus (womb). Pregnancy begins once a fertilized egg attaches to the womb.

Day 24 through 28

If the egg is not fertilized, it breaks apart. Around Day 24, your estrogen and progesterone levels drop if you are not pregnant. This rapid change in levels of estrogen and progesterone can cause your moods to change. Some women are more sensitive to these changing hormone levels than others. Some women feel irritable, anxious, or depressed during the premenstrual week but others do not.

In the final step of the menstrual cycle, the unfertilized egg leaves the body along with the uterine lining, beginning on Day 1 of your next period and menstrual cycle.

If you would like to understand your menstrual cycle in more depth, Medika recommends reading the following article The Menstrual Cycle explained, for more information.

The post A day by day guide to your menstrual cycle appeared first on Medika Life.

Menstruation is a woman’s monthly bleeding, often called your “period.” When you menstruate, your body discards the monthly buildup of the lining of your uterus (womb). Menstrual blood and tissue flow from your uterus through the small opening in your cervix and pass out of your body through your vagina.

During the monthly menstrual cycle, the uterus lining builds up to prepare for pregnancy. If you do not get pregnant, estrogen and progesterone hormone levels begin falling. Very low levels of estrogen and progesterone tell your body to begin menstruation.

What is the menstrual cycle?

The menstrual cycle is the monthly hormonal cycle a female’s body goes through to prepare for pregnancy. Your menstrual cycle is counted from the first day of your period up to the first day of your next period. Your hormone levels (estrogen and progesterone) usually change throughout the menstrual cycle and can cause menstrual symptoms.

How long is a typical menstrual cycle?

The typical menstrual cycle is 28 days long, but each woman is different.² Also, a woman’s menstrual cycle length might be different from month-to-month. Your periods are still “regular” if they usually come every 24 to 38 days.³ This means that the time from the first day of your last period up to the start of your next period is at least 24 days but not more than 38 days.

Some women’s periods are so regular that they can predict the day and time that their periods will start. Other women are regular but can only predict the start of their period within a few days. 

What is ovulation?

Ovulation is when the ovary releases an egg so it can be fertilized by a sperm in order to make a baby. A woman is most likely to get pregnant if she has sex without birth control in the three days before and up to the day of ovulation (since the sperm are already in place and ready to fertilize the egg as soon as it is released). A man’s sperm can live for 3 to 5 days in a woman’s reproductive organs, but a woman’s egg lives for just 12 to 24 hours after ovulation.

Each woman’s cycle length may be different, and the time between ovulation and when the next period starts can be anywhere from one week (7 days) to more than 2 weeks (19 days). Use this ovulation calculator as an aid to determining your ovulation dates .

At different times in a woman’s life, ovulation may or may not happen:

• Women who are pregnant do not ovulate.
• Women who are breastfeeding may or may not ovulate. Women who are breastfeeding should talk to their doctor about birth control methods if they do not want to get pregnant.
• During perimenopause, the transition to menopause, you may not ovulate every month.
• After menopause you do not ovulate.
   

How do I know if I’m ovulating?

A few days before you ovulate, your vaginal mucus or discharge changes and becomes more slippery and clear. This type of mucus helps sperm move up into your uterus and into the fallopian tubes where it can fertilize an egg. Some women feel minor cramping on one side of their pelvic area when they ovulate. Some women have other signs of ovulation.

Luteinizing hormone (LH) is a hormone released by your brain that tells the ovary to release an egg (called ovulation). LH levels begin to surge upward about 36 hours before ovulation, so some women and their doctors test for LH levels. LH levels peak about 12 hours before ovulation.¹ Women who are tracking ovulation to become pregnant will notice a slight rise in their basal temperature (your temperature after sleeping before you get out of bed) around ovulation. 

How does my menstrual cycle change as I get older?

Your cycles may change in different ways as you get older. Often, periods are heavier when you are younger (in your teens) and usually get lighter in your 20s and 30s. This is normal.

• For a few years after your first period, menstrual cycles longer than 38 days are common. Girls usually get more regular cycles within three years of starting their periods. If longer or irregular cycles last beyond that, see your doctor or nurse to rule out a health problem, such as polycystic ovary syndrome (PCOS).
• In your 20s and 30s, your cycles are usually regular and can last anywhere from 24 to 38 days.
• In your 40s, as your body starts the transition to menopause, your cycles might become irregular. Your menstrual periods might stop for a month or a few months and then start again. They also might be shorter or last longer than usual, or be lighter or heavier than normal.

Talk to your doctor or nurse if you have menstrual cycles that are longer than 38 days or shorter than 24 days, or if you are worried about your menstrual cycle.

Why should I keep track of my menstrual cycle?

If your periods are regular, tracking them will help you know when you ovulate, when you are most likely to get pregnant, and when to expect your next period to start.

If your periods are not regular, tracking them can help you share any problems with your doctor or nurse.

If you have period pain or bleeding that causes you to miss school or work, tracking these period symptoms will help you and your doctor or nurse find treatments that work for you. Severe pain or bleeding that causes you to miss regular activities is not normal and can be treated.

How can I keep track of my menstrual cycle?

You can keep track of your menstrual cycle by marking the day you start your period on a calendar. After a few months, you can begin to see if your periods are regular or if your cycles are different each month.

You may want to track:

• Premenstrual syndrome (PMS) symptoms: Did you have cramping, headaches, moodiness, forgetfulness, bloating, or breast tenderness?
• When your bleeding begins: Was it earlier or later than expected?
• How heavy the bleeding was on your heaviest days: Was the bleeding heavier or lighter than usual? How many pads or tampons did you use?
• Period symptoms: Did you have pain or bleeding on any days that caused you to miss work or school?
• How many days your period lasted: Was your period shorter or longer than the month before?

You can also download apps (sometimes for free) for your phone to track your periods. Some include features to track your PMS symptoms, energy and activity levels, and more.

When does a girl usually get her first period?

The average age for a girl in the United States to get her first period is 12.This does not mean that all girls start at the same age.

A girl may start her period anytime between 8 and 15. The first period normally starts about two years after breasts first start to develop and pubic hair begins to grow. The age at which a girl’s mother started her period can help predict when a girl may start her period.

A girl should see her doctor if:

• She starts her period before age 8.
• She has not had her first period by age 15.
• She has not had her first period within three years of breast growth.

How long does a woman usually have periods?

On average, women get a period for about 40 years of their life. Most women have regular periods until perimenopause, the time when your body begins the change to menopause. Perimenopause, or transition to menopause, may take a few years. During this time, your period may not come regularly. Menopause happens when you have not had a period for 12 months in a row. For most women, this happens between the ages of 45 and 55. The average age of menopause in the United States is 52.

Periods also stop during pregnancy and may not come back right away if you breastfeed.

But if you don’t have a period for 90 days (three months), and you are not pregnant or breastfeeding, talk to your doctor or nurse. Your doctor will check for pregnancy or a health problem that can cause periods to stop or become irregular.

What is a normal amount of bleeding during my period?

The average woman loses about two to three tablespoons of blood during her period. Your periods may be lighter or heavier than the average amount. What is normal for you may not be the same for someone else. Also, the flow may be lighter or heavier from month to month.

Your periods may also change as you get older. Some women have heavy bleeding during perimenopause, the transition to menopause. Symptoms of heavy menstrual bleeding may include:

• Bleeding through one or more pads or tampons every one to two hours
• Passing blood clots larger than the size of quarters
• Bleeding that often lasts longer than eight days

How often should I change my pad, tampon, menstrual cup, sponge, or period panties?

Follow the instructions that came with your period product. Try to change or rinse your feminine hygiene product before it becomes soaked through or full.

• Most women change their pads every few hours.
• A tampon should not be worn for more than 8 hours because of the risk of toxic shock syndrome (TSS)
• Menstrual cups and sponges may only need to be rinsed once or twice a day.
• Period panties (underwear with washable menstrual pads sewn in) can usually last about a day, depending on the style and your flow.

Use a product appropriate in size and absorbency for your menstrual bleeding. The amount of menstrual blood usually changes during a period. Some women use different products on different days of their period, depending on how heavy or light the bleeding is.  

What is toxic shock syndrome?

Toxic shock syndrome (TSS) is a rare but sometimes deadly condition caused by bacteria that make toxins or poisons. In 1980, 63 women died from TSS. A certain brand of super absorbency tampons was said to be the cause. These tampons were taken off the market.

Today, most cases of TSS are not caused by using tampons. But, you could be at risk for TSS if you use more absorbent tampons than you need for your bleeding or if you do not change your tampon often enough (at least every four to eight hours). Menstrual cups, cervical caps, sponges, or diaphragms (anything inserted into your vagina) may also increase your risk for TSS if they are left in place for too long (usually 24 hours). Remove sponges within 30 hours and cervical caps within 48 hours.

If you have any symptoms of TSS, take out the tampon, menstrual cup, sponge, or diaphragm, and call 911 or go to the hospital right away.

Symptoms of TSS include:

• Sudden high fever
• Muscle aches
• Vomiting
• Nausea
• Diarrhea
• Rash
• Kidney or other organ failure

How does the menstrual cycle affect other health problems?

The changing hormone levels throughout the menstrual cycle can also affect other health problems:

• Depression and anxiety disorders. These conditions often overlap with premenstrual syndrome (PMS). Depression and anxiety symptoms are similar to PMS and may get worse before or during your period.
• Asthma. Your asthma symptoms may be worse during some parts of your cycle.
• Irritable bowel syndrome (IBS). IBS causes cramping, bloating, and gas. Your IBS symptoms may get worse right before your period.
• Bladder pain syndrome. Women with bladder pain syndrome are more likely to have painful cramps during PMS.

The post Menstruation explained. Everything You Need to Know About the Menstrual Cycle appeared first on Medika Life.

Untreated heavy or prolonged bleeding can stop you from living your life to the fullest. It also can cause anemia. Anemia is a common blood problem that can leave you feeling tired or weak. If you have a bleeding problem, it could lead to other health problems. Sometimes treatments, such as dilation and curettage (D&C) or a hysterectomy might be done when these procedures could have been avoided with early treatment.

Causes

Possible causes fall into the following three areas:

1. Uterine-related problems
   1. Growths or tumors of the uterus that are not cancer; can be called uterine fibroids or polyps.
   2. Cervical and uterine cancer.
   3. Certain types of birth control—for example, an intrauterine device (IUD).
   4. Problems related to pregnancy, such as a miscarriage or ectopic pregnancy, can cause abnormal bleeding. A miscarriage is when an unborn baby (also called a fetus) dies in the uterus. An ectopic pregnancy is when a baby starts to grow outside the womb (uterus), which is not safe.
2. Hormone-related problems
3. Other illnesses or disorders
   1. Bleeding-related disorders, such as von Willebrand disease (VWD) or platelet function disorder.
   2. Nonbleeding-related disorders such as liver, kidney, or thyroid disease; pelvic inflammatory disease; and cancer.

In addition, certain drugs, such as aspirin, can cause increased bleeding. Doctors have not been able to find the cause in half of all women who have this problem. If you have bleeding such as this, and your gynecologist has not found any problems during your routine visit, you should be tested for a bleeding disorder.

You may exhibit the following symptoms

You might have menorrhagia if you:

• Have a menstrual flow that soaks through one or more pads or tampons every hour for several hours in a row.
• Need to double up on pads to control your menstrual flow.
• Need to change pads or tampons during the night.
• Have menstrual periods lasting more than 7 days.
• Have a menstrual flow with blood clots the size of a quarter or larger.
• Have a heavy menstrual flow that keeps you from doing the things you would do normally.
• Have constant pain in the lower part of the stomach during your periods.
• Are tired, lack energy, or are short of breath.

Diagnosing Menorrhagia

Finding out if a woman has heavy menstrual bleeding often is not easy because each person might think of “heavy bleeding” in a different way. Usually, menstrual bleeding lasts about 4 to 5 days and the amount of blood lost is small (2 to 3 tablespoons).

However, women who have menorrhagia usually bleed for more than 7 days and lose twice as much blood. If you have bleeding that lasts longer than 7 days per period, or is so heavy that you have to change your pad or tampon nearly every hour, you need to talk with your doctor.

To find out if you have menorrhagia, your doctor will ask you about your medical history and menstrual cycles.

He or she may ask you questions like the following:

• How old were you when you got your first period?
• How long is your menstrual cycle?
• How many days does your period usually last?
• How many days do you consider your period to be heavy?
• How do your periods affect your quality of life?

Your doctor may also ask if any of your family members have had heavy menstrual bleeding. He or she may also have you complete a questionnaire to help determine if you need to be tested for a possible bleeding disorder.

You might want to track your periods by writing down the dates of your periods and how heavy you think your flow is (maybe by counting how many pads or tampons you use). Do this before you visit the doctor so that you can give the doctor as much information as possible.

Possible Tests

Your doctor might tell you that one or more of the following tests will help find out if you have a bleeding problem:

• Blood test. In this test, your blood will be taken using a needle. It will then be looked at to check for anemia, problems with the thyroid, or problems with the way the blood clots.
• Pap test. For this test, cells from your cervix are removed and then looked at to find out if you have an infection, inflammation, or changes in your cells that might be cancer or might cause cancer.
• Endometrial biopsy. Tissue samples are taken from the inside lining of your uterus or “endometrium” to find out if you have cancer or other abnormal cells. You might feel as if you were having a bad menstrual cramp while this test is being done. But, it does not take long, and the pain usually goes away when the test ends.
• Ultrasound. This is a painless test using sound waves and a computer to show what your blood vessels, tissues, and organs look like. Your doctor then can see how they are working and check your blood flow.

Using the results of these first tests, the doctor might recommend more tests, including,

• Sonohysterogram. This ultrasound scan is done after fluid is injected through a tube into the uterus by way of your vagina and cervix. This lets your doctor look for problems in the lining of your uterus. Mild to moderate cramping or pressure can be felt during this procedure.
• Hysteroscopy. This is a procedure to look at the inside of the uterus using a tiny tool to see if you have fibroids, polyps, or other problems that might be causing bleeding. You might be given drugs to put you to sleep (this is known as “general anesthesia) or drugs simply to numb the area being looked at (this is called “local anesthesia”).
• Dilation and Curettage (D&C). This is a procedure (or test) that can be used to find and treat the cause of bleeding. During a D&C, the inside lining of your uterus is scraped and looked at to see what might be causing the bleeding. A D&C is a simple procedure. Most often it is done in an operating room, but you will not have to stay in the hospital afterward. You might be given drugs to make you sleep during the procedure, or you might be given something that will numb only the area to be worked on.

Treatment

The type of treatment you get will depend on the cause of your bleeding and how serious it is. Your doctor also will look at things such as your age, general health, and medical history; how well you respond to certain medicines, procedures, or therapies; and your wants and needs. For example, some women do not want to have a period, some want to know when they can usually expect to have their period, and some want just to reduce the amount of bleeding.

Some women want to make sure they can still have children in the future. Others want to lessen the pain more than they want to reduce the amount of bleeding. Some treatments are ongoing and others are done one time. You should discuss all of your options with your doctor to decide which is best for you. Following is a list of the more common treatments.

Drug Therapy

• Iron supplements. To get more iron into your blood to help it carry oxygen if you show signs of anemia.
• Ibuprofen (Advil). To help reduce pain, menstrual cramps, and the amount of bleeding. In some women, NSAIDS can increase the risk of bleeding.
• Birth control pills. To help make periods more regular and reduce the amount of bleeding.
• Intrauterine contraception (IUC). To help make periods more regular and reduce the amount of bleeding through drug-releasing devices placed into the uterus.
• Hormone therapy. To reduce the amount of bleeding.
• Desmopressin Nasal Spray (Stimate®). To stop bleeding in people who have certain bleeding disorders, such as von Willebrand disease and mild hemophilia, by releasing a clotting protein or “factor”, stored in the lining of the blood vessels that helps the blood to clot and temporarily increasing the level of these proteins in the blood.
• Antifibrinolytic medicines (tranexamic acid, aminocaproic acid). To reduce the amount of bleeding by stopping a clot from breaking down once it has formed.
• Oriahnn™ is a combination product containing elagolix, estradiol, and a type of progesterone called norethindrone acetate. Elagolix is a gonadotropin-releasing hormone antagonist. This term means it suppresses the ovarian sex hormones estrogen and progesterone, both of which stimulate fibroid growth.

Surgical Treatment

• Dilation and Curettage (D&C). A procedure in which the top layer of the uterus lining is removed to reduce menstrual bleeding. This procedure might need to be repeated over time.
• Operative hysteroscopy. A surgical procedure, using a special tool to view the inside of the uterus, that can be used to help remove polyps and fibroids, correct abnormalities of the uterus, and remove the lining of the uterus to manage the heavy menstrual flow.
• Endometrial ablation or resection. Two types of surgical procedures using different techniques in which all or part of the lining of the uterus is removed to control menstrual bleeding. While some patients will stop having menstrual periods altogether, others may continue to have periods but the menstrual flow will be lighter than before. Although the procedures do not remove the uterus, they can not be done on women who desire children in the future.
• Hysterectomy. A major operation requiring hospitalization that involves surgically removing the entire uterus. After having this procedure, a woman can no longer become pregnant and will stop having her period.

Menorrhagia is common among women. Many women do not know that they can get help for it. Others do not get help because they are too embarrassed to talk with a doctor about their problem. Talking openly with your doctor is very important in making sure you are diagnosed properly and get the right treatment.

Who is Affected

Heavy bleeding (menorrhagia) is one of the most common problems women report to their doctors. It affects more than 10 million American women each year. This means that about one out of every five women has it.

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