Imagine having to use 15 tampons or pads on the heaviest day of your period. Or skipping work for several days throughout each menstrual cycle because bleeding makes it impossible to leave your house. For roughly 30 per cent of women in Canada, this desperate monthly struggle with menstruation – a disorder the Society of Obstetricians and Gynecologists of Canada calls heavy menstrual bleeding – is their reality.

A debilitating condition
This debilitating condition doesn't discriminate by age or race. Heavy menstrual bleeding (HMB) can affect females as young as 12. It can leave women with life-threatening anemia, chronic fatigue and excruciating pelvic pain. Quality of life suffers as daily activities are interrupted.

Women afflicted spend exorbitant amounts of money on menstrual supplies such as tampons, pads, pain medications and even adult diapers during their menstrual cycle. And what's most tragic is that many women suffer in silence, not realizing that their excessive bleeding and discomfort are not part of a normal menstrual cycle. Fortunately, help is available.


What is normal menstruation?
According to Dr. Diane Francoeur, a gynecologist at Montreal's Sainte-Justine Hospital, a normal menstrual cycle can vary in length, but for most women it's approximately 28 to 32 days. Bleeding typically takes place over four to seven days.
"Normal menstruation [blood loss] is just 80 mL. It doesn't seem like much, but that's the usual amount of blood that we lose every month," she explains.

What are the symptoms of heavy menstrual bleeding?
If a woman experiences blood loss during their period exceeding 80 mL over several consecutive menstrual cycles, she could be suffering from HMB.

"If you bleed for more than a week, soak your bed at night or use more than six to eight pads a day, that's not normal," says Dr. Francoeur. "If you're changing your tampon every two hours for seven days, that's too much [blood loss]."

Other HMB symptoms include:
• needing to use a tampon and pad simultaneously;
• needing to change a tampon or pad more frequently than every two hours;
• wearing adult diapers to contain the blood flow;
• bleeding for more than seven consecutive days;
• a surge of blood upon standing;
• passing blood clots;
• missing work or social occasions because you can't leave home due to heavy bleeding;
• bleeding between periods; and
• periods less than 28 days apart or more than 35 days apart. What causes HMB?
Heavy menstrual bleeding is triggered by several conditions.

"You could have a disease of the uterus – fibroids, polyps, endometriosis, adenomyosis, uterine hypersplasia – that could increase the bleeding when you have your period," says Dr. Francoeur.

Other factors include bleeding disorders such as Von Willebrand disease, having an anovulatory cycle (a condition characterized by abnormal ovulation and prolonged or frequent bleeding) and obesity.

How can it be treated?
The old school of thought was that hysterectomy – the surgical removal of the uterus – was the only way to solve HMB. While this operation eliminated painful HMB, it also left its patients unable to become pregnant and on the verge of menopause. But with new medical and minimally invasive surgical breakthroughs, women with HMB have more treatment options than ever before.

Many doctors are turning to non-invasive hormone-based therapies to treat HMB: birth control pills, patches or intrauterine devices (IUDs). One IUD in particular, the Mirena IUD, receives Dr. Francoeur's praise.

"Since we started to put IUDs in, we do fewer hysterectomies," she says. "It's the favoured choice because it works well."

Hormone-based treatments like Mirena allow women to conquer HMB, keep their uteruses intact and retain their fertility.

Minimally invasive surgical options
For women who don't respond positively to hormone-based therapies, Dr. Francoeur says that the next step is minimally invasive surgical procedures such as myomectomy and endometrial ablation.

Myomectomy, cutting fibroids from the uterus, is often recommended for women with HMB who plan to have children. There are three methods: laparoscopic, which involves small abdominal incisions; hysteroscopic, which involves no incisions as it takes place via the vagina and cervix; or abdominal, which involves a large abdominal incision. Laparoscopic and hysteroscopic are the least invasive myomectomy procedures.

For endometrial ablation, tools are inserted into the vagina and through the cervix to burn and destroy the lining of the uterus. This minimally invasive technique is only suggested for women who are finished having a family or who don't plan on having children. While this procedure substantially decreases menstruation, it also seriously impacts the ability to become pregnant.

When surgery is required to fix HMB, minimally invasive procedures such as myomectomy and ablation are easier on the patient than a hysterectomy as they result in smaller incisions, less infection, fewer risks and a shorter recovery time.

Don't suffer in silence
The choice of an HMB treatment is a very personal decision. With many new techniques in tackling HMB – both medical and surgical – hysterectomies are no longer the only course of action. Non-invasive therapies allow women to take charge of their health and their future.

There's no reason to be frightened or to suffer in silence. If you think you might have heavy menstrual bleeding or an abnormal period, consult with your doctor for a diagnosis and discover the best treatment option for you.