As women age and progress towards menopause they often experience an increase in menstrual bleeding which creates significant quality of life challenge and sometimes even lost work time. Menstrual blood loss can be a significant cause of iron deficiency, and many women with heavy menstrual bleeding report that they fear leaving the house during their heaviest days of menstrual flow. Despite this being a significant challenge for women, women often don’t bring up their menstrual changes to their doctor nor are thir flow changes taken seriously when they do.
Here are three important considerations if you are noticing changes in the heaviness of your menstrual bleeding.
- Are you ovulating?
Ovulation, or releasing an egg, is a special timed event including hormones released from your brain and from your ovaries. In adolescence, the connection between the brain and ovaries is often not well-established and can sometimes lead to cycles where an egg is not released. These anovulatory cycles can increase the amount of blood that’s lost during menses. Progesterone is normally released during ovulation and is not released in a cycle without an egg. Progesterone matures and thins the uterine lining, to prepare the uterus for pregnancy. When pregnancy doesn’t occur, the uterine lining that has been matured by progesterone gets shed as a menstrual cycle. In anovulatory cycles progesterone is not released, and the uterine lining that needs to be shed at the end of the month is often thicker and more inflamed. As women approach menopause, they can also have anovulatory cycles as ovarian function declines, which can account for the increase in menstrual blood flow in women over the age of 40. Simple and inexpensive hormone testing can help your Naturopathic Doctor understand if you are ovulating in your monthly cycle.
2. Are you iron deficient?
Ironically, iron is part of the clotting cascade that helps slow blood loss during the menstrual cycle. Women who have heavy menstrual periods are at risk for iron deficiency and having low iron actually increases the amount of blood loss every month. Women can easily be assessed for iron deficiency through simple blood test and may need optimal iron levels (women want to be better than the low end of the reference range) to see a change in their menstrual blood flow.
3. Is there something else going on?
Uterine fibroids and adenomyosis are the most common structural causes of heavy menstrual bleeding. Because both of them can only be assessed by ultrasound, it often leaves many women with heavy menstrual bleeding for years before things are properly looked into. The size and severity of uterine fibroids usually increases with age, which often explains the increase in menstrual bleeding in women in their late 40s. Although fibroids and adenomyosis improve after menopause for many women in the amount of blood loss and inconvenience for years preceding menopause can interfere with their quality of life.
If you are noticing changes in your monthly menstrual blood flow, be sure to address it with your family doctor, your gynaecologist or your Naturopathic Doctor. Untreated heavy menstrual blood flow increases the risk of iron deficiency in women of all ages and the lower a woman’s iron falls the greater the risk for further heavy menstrual bleeding. Simple blood tests and a thorough history taking can help your doctor understand the cause of your heavy menstrual bleeding or the need for more investigation such as an ultrasound.