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Essential Inquiries to Ask About Heavy Uterine Bleeding and Its Potential Problems: Q & A with Dr. Rashmi Kudesia

Medically verified by Dr. Rashmi Kudesia

If you have to wake up in the middle of the night to change your menstrual products, have been bleeding for more than a week, or have large blood clots, it could be a sign of heavy uterine bleeding (HUB), also known as menorrhagia.

While menstruating women often have days when their flow is heavier than others, one in four women suffers from HUB. The disease can significantly disrupt the lives of women and even cause some to give up their daily activities. If this sounds like you, it’s time to speak to your doctor.

Dr. Rashmi Kudesia, Assistant Professor of Obstetrics and Gynecology at CCRM Fertility and Houston Methodist Hospital and a member of the HealthyWomen’s Women’s Health Advisory Council, spoke to us about HUB and Iron Deficiency Anemia (IDA). The interview has been edited for clarity and length.

Healthy women: Symptoms of HUB include menstrual flow that requires women to change their period products every hour for several hours in a row, a cycle that lasts longer than seven days, pain in the lower part of the stomach, and fatigue. How should women speak to their health care providers to ensure their concerns are not dismissed as typical period symptoms?

Rashmi Kudesia: The first step is to track your periods and symptoms, ideally for at least a few months. Then you can see your doctor and say something like, “By tracking my periods, I’ve learned that I usually bleed 12-14 days a month,” or “I have severe debilitating pain for five days at a time.” Month. “These types of specific statements are more useful than non-specific complaints like” I have heavy periods “.

Healthy women: HUB can be caused by uterine fibroids, polyps, cancer, or estrogen or progesterone hormone imbalances. What questions should women ask their health care providers to help determine the cause of their condition?

Rashmi Kudesia: As soon as you have tracked your cycles and presented this data to your provider, they should be able to clarify whether you are experiencing anything extraordinary. Your provider will then identify the cause before treatment begins. The appropriate tests will depend on your symptoms, but often include a transvaginal ultrasound to take a look at the uterus and sometimes a saline ultrasound or other similar tests that are more likely to involve structural problems such as fibroids or polyps in the uterine cavity.

Coupled with irregular or unpredictable cycles, HUB can indicate hormonal abnormalities that may be related to the thyroid gland, lack of ovulation, or polycystic ovary syndrome.

Healthy women: What are the long-term health effects of women if HUB is left untreated?

Rashmi Kudesia: A major problem with long-term, uncontrolled bleeding is the loss of iron, which is needed to produce hemoglobin, a substance in red blood cells that carries oxygen around the body. This iron deficiency is known as iron deficiency anemia (IDA). Symptoms of this condition include tiredness, headache, drowsiness, and palpitations. IDA can also be asymptomatic, so some women may not have symptoms. If you experience HUB for six months or more, it could lead to IDA. If the heavy bleeding is due to longer cycles associated with the failure to ovulate – where the abnormal hormonal pattern can lead to uncontrolled bleeding that lasts for weeks – there is also a risk of developing precancerous and cancerous changes in the cells inside the uterus.

Healthy women: HUB and IDA are two separate conditions. Should they be treated together or separately?

Rashmi Kudesia: Both diseases should be assessed and treated together. If the bleeding is causing the anemia, treatment is of paramount importance. If a woman receives treatment for HUB, she should also have a full work-up to see if the bleeding was causing IDA. (Other causes of the condition include a lack of iron in your diet, your body’s inability to absorb iron, pregnancy, or other causes of blood loss such as gastrointestinal bleeding.)

Healthy women: What are the treatments for HUB? Can any of them handle IDA as well?

Rashmi Kudesia: Treatment for HUB includes medical treatment with hormonal drugs, most commonly hormonal contraceptives, and sometimes surgery, depending on the cause of the bleeding. Iron supplementation is only a treatment for IDA, not HUB. Ibuprofen is used to relieve menstrual cramps related to HUB, which can be more severe under certain conditions that predispose to heavy bleeding (e.g. fibroids).

Some of the treatments for HUB may actually help women living with IDA. For example, hormonal birth control can help reduce the amount and frequency of bleeding. As a result of this treatment, women with IDA can build up their iron stores over time and rebuild their blood counts. However, it’s important to note that while taking iron supplements can help this process go faster, it doesn’t treat the bleeding.

Healthy women: Do HUB and IDA wear off after treatment or are they conditions that women need to monitor separately and treat for the rest of their menstrual lives?

Rashmi Kudesia: Both conditions can subside depending on the cause. For example, a uterine fibroid or polyp can be easily removed, although there is a risk of possible regrowth. Hormonal abnormalities can be treated by changing lifestyle and / or using hormonal birth control. In most cases, the only permanent cure option would be hysterectomy, but it should not be the first line of treatment.

Healthy women: Are There Risk Factors For Treating HUB And IDA?

Rashmi Kudesia: Treatments are generally benign, but some side effects may occur. Iron pills can cause gastrointestinal discomfort and some women should not use hormonal birth control if they smoke, have high blood pressure, or have other specific medical conditions. Hormonal contraceptives can slightly increase the risk of blood clots, especially in women at risk.

Healthy women: Are there treatments for HUB that may conflict with treatments for IDA?

Rashmi Kudesia: No, these treatments would generally work in harmony rather than conflict. Surgical approaches that involve significant blood loss could further lower the blood count temporarily, but they would also help resolve the anemia.

Healthy women: Women with IDA are recommended to eat foods rich in iron such as spinach, seafood, beans, and red meat, and foods high in vitamin C such as broccoli, tomatoes, strawberries, and leafy vegetables. Can the same diet help women suffering from HUB?

Rashmi Kudesia: This diet helps women with IDA to restore their iron levels and are well equipped to absorb the iron. With the exception of red meat, these foods are generally healthy choices that are good for overall health. However, they will not reverse the hormonal or structural problem that is behind the profuse bleeding.

For more information on HUB and IDA, please visit imayhaveida.com.

This resource was created with the assistance of Daiichi Sankyo, Inc.

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