Heavy Menstrual Bleeding: Causes, Concerns, and Solutions for Women Over 40

Heavy menstrual bleeding?

Hello, Doctor: I am 46 years old and had a Mirena IUD inserted about three years ago.
I have been experiencing heavy menstrual bleeding, with a cycle of approximately 25 to 28 days, and my periods last around ten days, with lighter flow during the last 2 to 3 days.
I had a Pap smear two years ago, which came back normal.
Before the test, I usually wipe myself clean with a damp tissue; could this have affected the test results? One doctor mentioned that I have adenomyosis, while another said I do not.
Am I approaching menopause? Is my irregular menstruation related to the impending menopause, or could it be due to fibroids or something else? Additionally, my hemoglobin level is 8.3; should I be concerned about not taking iron supplements? Will anemia improve after menopause? I would greatly appreciate your response!

Ah Hui, 40~49 year old female. Ask Date: 2004/07/31

Dr. Wu Zongcheng reply Obstetrics and Gynecology

Dr.
Wu Zongcheng from the Tainan Hospital of the Department of Health, Executive Yuan, responded:
1.
For heavy menstrual bleeding, first identify the cause (diagnosis):
a.
Uterine tumors (including fibroids and adenomas) can be evaluated through ultrasound and pelvic examination.

b.
An unsuitable intrauterine device (IUD) may lead to poor uterine contractions.

c.
Some individuals may experience irregular menstruation in the one to two years prior to menopause (endocrine hormone testing).

2.
A hemoglobin level of 8.3 is too low; iron supplementation is advisable, but finding the correct diagnosis and providing targeted treatment is the best approach.

Tainan Hospital wishes you good health and all the best!

Reply Date: 2004/07/31

More Info

Heavy menstrual bleeding, also known as menorrhagia, can be a significant concern for women, especially those over 40. As women approach perimenopause and menopause, hormonal fluctuations can lead to changes in menstrual patterns, including heavier bleeding and longer periods. In your case, at 46 years old and with a history of using an intrauterine device (IUD), it is essential to consider various factors that could contribute to your symptoms.

Firstly, the presence of an IUD can sometimes lead to heavier menstrual bleeding. While many women find that hormonal IUDs can reduce menstrual flow, others may experience the opposite effect, particularly with non-hormonal IUDs. If you have been using the IUD for three years and are experiencing increased bleeding, it may be worth discussing with your healthcare provider whether the IUD is the right choice for you at this stage in your life.

Regarding your menstrual cycle, a cycle length of 25-28 days with periods lasting around ten days, especially with heavy bleeding, is not uncommon as women approach menopause. The hormonal changes during this time can lead to a thickening of the endometrial lining, which may result in heavier bleeding when it is shed. This condition is sometimes referred to as dysfunctional uterine bleeding (DUB), which is often related to hormonal imbalances.

You mentioned that one doctor suggested the presence of adenomyosis (often referred to as "adenomyoma"), which is a condition where the endometrial tissue grows into the muscular wall of the uterus. This can cause heavy bleeding and painful periods. However, if another doctor indicated that there was no such condition, it may be beneficial to seek a third opinion or request further imaging studies, such as an ultrasound, to clarify the situation.

Your concern about anemia is valid, especially with a hemoglobin level of 8.3, which indicates a potential for significant anemia. Heavy menstrual bleeding can lead to iron deficiency anemia, which can cause fatigue, weakness, and other health issues. It is crucial to address this by either increasing your dietary iron intake or considering iron supplementation, as advised by your healthcare provider. While it is true that some women may experience an improvement in anemia after menopause due to the cessation of menstruation, it is not advisable to wait until then to address your current anemia.

In summary, your heavy menstrual bleeding could be related to a combination of factors, including the IUD, hormonal changes associated with perimenopause, and possibly underlying conditions such as adenomyosis or fibroids. It is essential to have a thorough evaluation by a healthcare provider who can assess your symptoms, perform necessary tests, and discuss appropriate treatment options. This may include hormonal therapies, adjustments to your contraceptive method, or other interventions to manage your bleeding and improve your overall health. Regular follow-ups and monitoring are crucial during this transitional phase of life to ensure that any potential issues are addressed promptly.

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