Abnormal uterine bleeding can be a concerning symptom for many women. Some women may experience prolonged or heavy menstrual bleeding that can last for years. While not typical, it is possible for women to have menstrual periods that last for extremely long durations. There are various medical conditions that can cause excessive bleeding, which need to be evaluated by a doctor to determine the underlying cause. With the right treatment, it may be possible to get abnormal bleeding under control and restore normal menstruation cycles.
What is considered abnormal uterine bleeding?
Menstrual bleeding is considered abnormal if it occurs at irregular intervals, lasts longer than 7 days, involves heavy flow or clotting, or happens between periods. Some key characteristics of abnormal uterine bleeding include:
- Menstrual periods that are longer than 7 days
- Bleeding or spotting between periods
- Irregular periods with inconsistent cycle length
- Bleeding after sex
- Heavier flow than usual, needing to change pads or tampons more frequently
- Passing blood clots larger than a quarter
Any bleeding that disrupts a woman’s normal cycle or daily life is considered abnormal. While occasional irregularities can happen, frequent or prolonged abnormal bleeding warrants medical evaluation.
What causes prolonged bleeding in women?
There are various gynecological conditions that can lead to heavy, persistent menstrual bleeding lasting for years in some cases. Some potential causes include:
Uterine fibroids
Noncancerous growths in the uterus called fibroids are a common cause of heavy bleeding. Fibroids emerge from the muscular wall of the uterus and can range in size. Submucosal fibroids that grow just under the uterine lining tend to cause the most bleeding issues. The exact reason fibroids cause heavy bleeding is not fully understood, but they may distort the shape of the uterine cavity or alter hormone signaling.
Endometriosis
This condition involves tissue similar to the uterine lining growing outside of the uterus, such as on the ovaries or fallopian tubes. These tissue deposits break down each month in response to hormonal changes, which can cause bleeding. Endometriosis may also contribute to heavy periods by its influence on prostaglandins, inflammation-triggering chemicals involved in menstruation.
Adenomyosis
In adenomyosis, the uterine lining grows into the muscular wall of the uterus. This leads to swelling of the uterus and disrupted menstrual flow. Adenomyosis often appears in middle age and may cause not only heavy flow but also painful menstrual cramps.
Hormone imbalances
Hormonal disorders involving estrogen and progesterone can prevent normal build-up and shedding of the uterine lining. Low progesterone relative to estrogen is a common driver of abnormal bleeding. Conditions like polycystic ovarian syndrome (PCOS), thyroid problems, and some tumors can create hormone imbalances resulting in prolonged, heavy periods.
Intrauterine devices (IUDs)
While IUDs are excellent contraceptives for most women, a small percentage may experience persistent bleeding and spotting. This tends to improve over time, but heavier menstrual bleeding is most common in the first 3-6 months after IUD insertion.
Pregnancy complications
Some pregnancy-related conditions like miscarriage, ectopic pregnancy, and gestational trophoblastic disease can provoke abnormal bleeding. Retained products of conception after pregnancy loss or childbirth can also lead to prolonged bleeding.
Medications
Certain medications like blood thinners, antidepressants, and chemotherapy drugs may interfere with normal blood clotting. This can allow menstrual bleeding to become heavier and persist longer.
Blood clotting disorders
Problems with blood coagulation can result in menorrhagia, or excessive menstrual bleeding. For example, von Willebrand disease inhibits blood clotting, while platelet disorders reduce platelet count or function. These bleeding disorders tend to run in families.
Uterine or cervical cancer
In rare cases, abnormal bleeding may be a sign of uterine or cervical cancer. While most causes of abnormal bleeding are benign, persistent bleeding after menopause warrants medical evaluation to check for cancer.
No identifiable cause
For approximately 20-30% of women with heavy menstrual bleeding, the cause remains unknown even after evaluation. The abnormal bleeding is referred to as dysfunctional uterine bleeding in these idiopathic cases.
How is prolonged menstrual bleeding evaluated?
To get to the root of prolonged, heavy periods, doctors use the following diagnostic approaches:
Medical history
The patient is asked about the extent of bleeding, pain, related symptoms, medication use, reproductive history, and family history of bleeding disorders. Age of onset and pattern of abnormal bleeding provide important clues.
Pelvic exam
Looking for abnormalities in the reproductive tract like fibroids, discharge, or tenderness.
Pregnancy test
To rule out pregnancy complications as the cause.
Blood tests
Count and functionality of red blood cells, platelets, and coagulation factors may be examined. Thyroid tests help assess for hormone imbalances.
Endometrial biopsy
Taking a sample of the uterine lining to check for cell abnormalities. This can detect conditions like cancer or chronic endometritis.
Ultrasound
Imaging tests allow visualization of the reproductive organs. Ultrasound can detect fibroids, polyps, thickened uterine lining, and other structural issues.
Hysteroscopy
Involves inserting a tiny camera into the uterus for direct visualization of the endometrium. May be done to screen for cancer.
Dilation and curettage (D&C)
Removes a sample of the uterine lining using a special instrument. Examination of the tissue can reveal problems.
| Test | Purpose |
|---|---|
| Medical history | Identify pattern and characteristics of bleeding |
| Pelvic exam | Check for abnormalities in reproductive tract |
| Pregnancy test | Rule out pregnancy complications |
| Blood tests | Evaluate blood cells, hormones, clotting factors |
| Endometrial biopsy | Examine cells of uterine lining |
| Ultrasound | Visualize reproductive organs |
| Hysteroscopy | Directly inspect the uterine cavity |
| Dilation and curettage (D&C) | Obtain uterine tissue sample |
How is heavy prolonged menstrual bleeding treated?
Treatment depends on the underlying cause but may involve:
Hormonal medications
Birth control pills or progestin therapies help stabilize the build-up and shedding of the uterine lining. This reduces the heaviness of menstrual flow.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Ibuprofen or naproxen sodium decreases prostaglandin levels, lowering uterine cramping and bleeding.
Antifibrinolytic agents
Medications like tranexamic acid work by blocking breakdown of blood clots. This allows better clotting and control of menstrual flow.
Desmopressin
This medication elevates von Willebrand factor and factor VIII levels in those with bleeding disorders. It helps improve platelet function and blood clotting.
Gonadotropin-releasing hormone (GnRH) agonists
These drugs repress ovulation and decrease estrogen production. This induces a menopausal state to minimize menstrual bleeding.
Endometrial ablation
Destruction of the uterine lining using heat, freezing, or other methods. This reduces the amount of tissue available to bleed each month.
Uterine artery embolization
Blocking the arteries supplying blood flow to fibroids causes them to shrink and bleed less. Helpful for fibroid-related menorrhagia.
Myomectomy
Surgical removal of fibroids while preserving the uterus. May allow return to normal menstrual flow.
Hysterectomy
Surgical removal of part or all of the uterus. This definitively stops all uterine bleeding. Reserved for severe bleeding when other options fail.
What is the outlook for women with prolonged menstrual bleeding?
With appropriate evaluation and treatment of the underlying cause, many women can achieve significant improvement or complete resolution of prolonged heavy bleeding. However, this may be a chronic, lifelong condition for some women. Supportive care and lifestyle changes can help coping. Open communication with your healthcare provider is key to finding an optimal management plan.
Some cases of intractable bleeding may ultimately require surgical interventions like endometrial ablation or hysterectomy to control symptoms. But the good news is most women with heavy, persistent menstrual bleeding can experience great relief using medications, less invasive procedures, complementary therapies, and healthy lifestyle habits tailored to their needs. This allows them to regain comfort and quality of life.
Conclusion
While heavy and prolonged menstrual bleeding is distressing, women do not have to resign themselves to years of abnormal periods. There are solutions available, whether the cause is fibroids, endometriosis, hormonal dysfunction, or another medical issue. Doctors can run tests to determine if there is an underlying gynecological condition contributing to persistent bleeding. Treatment options ranging from medications to surgical procedures can often remedy prolonged heavy bleeding or at least significantly improve it. With a proactive and integrative approach focused on personalized care, most women can find an effective way to get their menstrual cycles back to normal.