Medically verified by Dr. Rashmi Kudesia
Many women experience a heavy flow day or two when they have their periods. But if you’re like the 10 million American women who experience profuse uterine bleeding (also called HUB or menorrhagia), your river may feel more like a broken levee than a small, manageable stream.
HUB can disrupt a woman’s everyday life, and losing that much blood can also lead to iron loss, which can lead to another potentially serious condition called iron deficiency anemia (IDA). Are you wondering if you might have HUB or IDA? HealthyWomen spoke to Dr. Rashmi Kudesia, Assistant Professor of Obstetrics and Gynecology at CCRM Fertility and Houston Methodist Hospital and a member of the HealthyWomen Women’s Health Advisory Council, to learn more about the symptoms and treatment of these two related but different diseases.
How do you know if you have profuse uterine bleeding?
If your period lasts longer than seven days, you may experience profuse uterine bleeding. Additional symptoms include soaking one or more tampons or menstrual pads every hour for many hours in a row, going through blood clots that are larger than a quarter, or doubling up on pillows to prevent leakage.
Kudesia said menstrual cycles should be used as vital signs because they can tell women a lot about their overall health. To get a better sense of their cycles, she said women with HUB symptoms should monitor their bleeding and pain symptoms. For example, how many days does bleeding occur? How Often Do You Pass Large Lumps? Are you taking days off from work or school because of bleeding or pain? Recording as much of your symptoms as possible can provide detailed answers to your healthcare provider questions about your experience – and this will help them figure out what to do next.
For example, a doctor may ask you to take a blood sample, do a Pap test, take a sample of tissue from inside your uterus, or give you an ultrasound. Not only can these tests and procedures help confirm your HUB, but they can also rule out potentially more serious problems such as precancerous lesions in your uterus.
One of the best ways to find out if your bleeding is normal, Kudesia said, is to just keep doing what you’re probably already doing: “Talk to your friends.” Hearing the experiences of other women can help you get a feel for whether your symptoms are out of the norm even while making small talk.
What is iron deficiency anemia and what does it have to do with HUB?
Chronic blood loss can lead to the loss of too much iron, which is needed to make hemoglobin, a substance found in red blood cells that carries oxygen around the body. This lack of adequate iron is aptly referred to as iron deficiency anemia. While HUB is common – nearly 25 percent of women have HUB – many women are still unaware that experiencing HUB can lead to IDA for six months or more.
Kudesia says symptoms of IDA can be non-specific, including fatigue, headache, pale skin, cold hands and feet, and shortness of breath. However, some women do not realize they are anemic because the blood loss over time and only gradually depletes iron. Some women with IDA may not have symptoms. Therefore, even if you do not have any symptoms of HUB other than blood loss, it is important that you see a doctor who can both confirm a diagnosis for HUB and do a blood test to check for IDA.
It’s important to remember that while HUB and IDA are separate conditions, they must be treated together, Kudesia said. “Fix the problem,” she said, “instead of putting a band-aid on it.”
Additionally, Kudesia said that after diagnosing HUB and IDA, your doctor will need to confirm that your iron deficiency is actually caused by your heavy periods. This is because some iron deficiencies are not caused by blood loss, but rather by your body’s inability to get iron into the bloodstream of your small intestine, an iron deficiency in your diet or pregnancy.
Treatment options for HUB and IDA
Kudesia said there are two ways to treat HUB: medical and surgical. Medical therapies may include nonsteroidal anti-inflammatory drugs like ibuprofen or naproxen to reduce blood loss. Oral contraceptives, the hormone progesterone, or a hormonal IUD may also be prescribed to correct a hormone imbalance or to regulate menstrual cycles.
A number of surgical procedures, including hysterectomy (removal of the uterus and cervix), are often used as a last resort for younger women who may still want to have children, or for women of all ages after other medical therapies have proven unsuccessful, it said Kudesia.
Treatment for IDA will depend on the severity of your symptoms. Changing your diet or taking iron supplements are recommended treatment options for an initial IDA diagnosis. Depending on the severity of the diagnosis and whether an oral supplement is an effective iron substitute, intravenous iron or red blood transfusions may be recommended.
Kudesia said that in addition to tracking your symptoms, you should try to learn as much about your family history as possible before seeing a doctor. In order to become empowered and take responsibility for your own health, you should also be armed with questions to ask during your appointment. Questions can be:
- I’ve been tracking my symptoms – based on what I’ve recorded, what tests or procedures do you recommend to confirm I have HUB and / or IDA?
- Do you think you need to do an ultrasound to look for uterine fibroids (which are non-cancerous growths in the uterus that may contribute to HUB)?
- Do you think medical or surgical treatments will work better for me?
- If you prescribe medical, not surgical, treatment, will my HUB repeat over time?
- How do different treatment options for HUB affect my family planning?
- If I am diagnosed with IDA, do you think diet or iron supplementation will work for me?
For more information on HUB and IDA, please visit imayhaveida.com.
This resource was created with the assistance of Daiichi Sankyo, Inc.