Medically verified by Dr. Rashmi Kudesia
We may not hear much about it, but profuse uterine bleeding (HUB) is one of the most common gynecological complaints affecting roughly one in four women in the United States.
The main reason so many of us haven’t heard from HUB is because of the stigma associated with periods. In other words, most women don’t talk about their bleeding.
“We haven’t really taught women what a normal amount of bleeding is, what is heavy, and what is easy,” said Dr. Cindy Duke, clinical assistant professor at the University of Nevada, Las Vegas School of Medicine. Because menstruation is a taboo subject in many cultures, many women may not realize that their periods are unusually heavy or unusually long, Duke said. Often times, the bleeding progresses gradually or is not painful, making it even more difficult for women to tell if there is a problem.
What is profuse uterine bleeding?
HUB is defined either by bleeding that lasts longer than seven days or by bleeding that is very profuse.
“Doctors consider heavy bleeding to be greater than 80 milliliters,” Duke said. “But if you don’t use a cup, patients can’t see what it looks like.” Instead, most healthcare providers tell their patients that soaking two or more maxi pads in an hour will cause profuse bleeding – more than that can be an emergency. A good rule of thumb, Duke said, is that when you see a doctor, you should turn to four pads within two hours.
If a woman has easy or normal flow, but the bleeding time is more than seven days, it is also considered severe. Passing blood clots larger than a quarter is also considered heavy bleeding, according to the CDC.
What are the symptoms and causes of HUB?
“Most people don’t come to the doctor’s office because they bleed too much,” says Duke. “They come to their doctor about the symptoms of excessive bleeding, and it may take them a while to find out that excessive bleeding is the cause.”
Heavy bleeding over time can lead to iron deficiency anemia (IDA), a condition in which the body lacks enough red blood cells to carry oxygen to organs and tissues. While HUB is common – nearly 25 percent of women have HUB – many women are unaware that experiencing HUB can lead to IDA for six months or more. IDA can cause symptoms such as drowsiness, palpitations, fatigue, weakness, headache, and shortness of breath. However, some women may not experience symptoms.
While this isn’t always the case, HUB can also be painful due to an underlying condition called adenomyosis, which affects the lining of the uterus, or from passing through large blood clots.
In addition to heavy periods, HUB can be caused by a number of medical conditions. Two of the more serious diseases are genetic and birth bleeding disorders such as haemophilia or factor X deficiency. Other causes include underlying liver disease, an endocrine disorder such as polycystic ovarian syndrome (PCOS), or benign uterine growths such as fibroids or polyps. In more severe cases, heavy bleeding or abnormal bleeding outside of menstruation can be a sign of uterine cancer.
When should i speak
HUB is common, but most women don’t talk about it – some women may not even know there is a problem.
“It’s not really a conversation you will have with your girlfriends to exchange notes about your period,” says Duke. And even when women realize they may have a problem, fear of medical intervention or certain cultural beliefs can prevent them from speaking up. “Women sometimes fear the doctor will have to remove their uterus, or they think heavy bleeding is just the cost to a woman, the price you have to pay to have babies,” Duke said.
However, it is important to break the silence and stigma surrounding HUB. After all, menstruation is a common experience of billions of women. “Nobody should get relegated if they have heavy periods or are in constant pain,” says Duke. “Most of the time, heavy bleeding is an easily treatable problem – but I can’t fix it if I don’t know about it.”
In the midst of the COVID-19 pandemic, it seems to be more difficult to keep appointments with health care providers, but Duke urges women to take their annual OB / GYN exams. These visits are essential, Duke said, and they involve much more than just a pap smear or a pelvic exam: “The pap smear is separate from your annual exam. During an annual exam, we determine your period status and how you are doing on intercourse and intimacy pain – and these problems or problems with excessive bleeding can be addressed before they get too bad or unbearable. “
For more information on HUB and IDA, please visit imayhaveida.com.
This resource was created with the assistance of Daiichi Sankyo, Inc.