Understanding Heavy Menstrual Bleeding in Adolescents

Many women experience irregular and how’s-it-going-to-this-month-! periods in their adolescence as their body is still trying and figuring out how to establish regular ovulatory cycles. So, you can expect adolescents to experience long and heavy bleeding during periods in the years following their menarche – the first period.

But what exactly is heavy menstrual bleeding? How ‘heavy’ does your periods have to be to be termed ‘heavy menstrual bleeding’? And when exactly should you be concerned? Read on to learn more!

What is heavy menstrual bleeding?

With normal menstrual bleeding, tampons or sanitary pads would need to be changed every 3 or 4 hours. But with heavy menstrual bleeding – or menorrhagia as it’s clinically called, you’d need a heavy flow period pad change every two hours!

The symptoms with which you can identify heavy menstrual bleeding are as follows:

• Period lasting more than 7 days
• More than 80ml of discharge during periods (now measuring discharge is not practical, so just remember that soaking through a heavy period pad every two hours is a warning sign)
• Heavy periods with blood clots
• Anemia or blood loss symptoms such as tiredness, dizziness, or inability to focus at school

Also be on the lookout for these additional symptoms that might make diagnosis easier:

• Frequent nosebleeds (more than 5 times in a year cab be termed frequent)
• Bruising easily
• Bleeding excessively after dental procedures, bruises, and surgeries

What are the causes of heavy menstrual bleeding in adolescents?

There are numerous possible causes of menorrhagia in adolescents which can make diagnosis hard, often resulting in misdiagnosis. However, the most common reason for heavy periods in adolescents is anovulatory cycles – menstrual cycles where a woman skips ovulation resulting in increased intervals between periods.

Other common causes of heavy menstrual bleeding include:

Endocrine disorders:

The endocrine system is responsible for producing and regulating hormones, including those involved in the menstrual cycle. And any imbalances in hormones such as estrogen and progesterone can result in heavy periods. Some common endocrine causes include:

• Thyroid dysfunction: Thyroid hormones play a crucial role in regulating the menstrual cycle. Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) can disrupt the hormonal balance necessary for a regular menstrual cycle and result in heavy menstrual bleeding.
• Polycystic Ovarian Syndrome (PCOS): PCOS is a hormonal disorder characterized by the presence of multiple small cysts on the ovaries. It is associated with an imbalance of reproductive hormones, particularly increased androgen levels which – you guessed it – can result in heavy menstrual bleeding.

Hematological causes:

Any abnormalities in the blood or blood-clotting factors can affect the body’s ability to control bleeding, including during menstruation. These conditions can be inherited or acquired and can lead to excessive bleeding or prolonged clotting times:

• Von Willebrand Disease: Von Willebrand Disease is a genetic bleeding disorder caused by a deficiency or dysfunction of von Willebrand factor (vWF), a protein necessary for proper blood clotting. Adolescents with this condition may experience heavy menstrual bleeding due to impaired clotting ability.
• Platelet Function Disorder: Platelets are blood cells involved in clotting. Platelet function disorders refer to conditions in which platelets do not function properly, leading to impaired blood clotting.
• Thrombocytopenia: Thrombocytopenia is a condition characterized by a low platelet count in the blood. Insufficient platelets can impair the blood’s ability to form clots, leading to heavy bleeding in affected adolescents.

Medications:

Medication-induced causes of heavy menstrual bleeding refer to the effects certain medications have on the menstrual cycle, which can result in increased or prolonged bleeding.

• Hormonal Contraception: Some hormonal contraceptives, such as intrauterine devices (IUDs) or contraceptive implants, may cause heavy menstrual bleeding as a side effect. The hormonal changes induced by these contraceptives can affect the thickness of the endometrium (innermost layer of the uterus), leading to heavier periods.
• Anticoagulants: Anticoagulant medications, which are used to prevent blood clot formation, can contribute to heavy menstrual bleeding. These medications interfere with the normal clotting process, making it difficult for the body to control bleeding during menstruation.

Other causes:

• • Physical trauma: Injury to the reproductive organs or the uterus caused by accidents, falls, or certain medical procedures can disrupt the normal structure and functioning of the uterus, leading to heavy bleeding during menstruation.
  • Infection: Infections of the reproductive organs, such as pelvic inflammatory disease (PID) or sexually transmitted infections (STIs), can cause inflammation and damage to the uterus or cervix. This can result in heavy menstrual bleeding.
  • Cancer: Although rare, malignant tumors in the reproductive organs – such as cervical, uterine, or ovarian cancer – can disrupt the normal menstrual cycle and lead to abnormal bleeding patterns.
  • Structural Causes (Uncommon in Adolescence): Structural abnormalities of the uterus, such as uterine fibroids (non-cancerous growths in the uterus) or uterine polyps, can also lead to heavy periods. While these conditions are generally more common in older individuals, they can also occur in adolescents.

How is diagnosis for heavy menstrual bleeding done?

Your doctor will begin by asking questions about your medical history and menstrual cycles. Then your doctor will examine you for signs and symptoms of anemia such as low blood pressure, breathlessness, and increased heart rate. Then your doctor will also examine you for pallor (pale skin), petechiae (tiny spots due to bleeding under the skin), and bruises to rule out any hematological causes.

After this initial test, your doctor may recommend one or more of the following tests to arrive at an accurate diagnosis:

• • • Blood tests: To rule out iron deficiency, abnormalities in the blood or blood-clotting factors, and endocrine disorders.
    • Endometrial biopsy: A sample of tissue from the inside of the uterus is taken to be examined by a pathologist.
    • Ultrasound: Images of the uterus, ovaries, and pelvis are produced using sound waves to look for any abnormalities.
    • Hysteroscopy: A thin, lighted tube is inserted through your vagina and crevix and into the uterus, allowing the doctor to see the inside of the uterus.
    • Your doctor might recommend even more tests to rule out other menstrual disorders, medical conditions, and medications as potential causes of heavy menstrual bleeding. This will help ensure that you receive an accurate diagnosis.

Treatment Options for Heavy Menstrual Bleeding in Adolescents

Non-surgical treatment options

Non-surgical treatment options for heavy menstrual bleeding are typically the first line of defense against this condition.

Non-pharmacological management

Non-pharmacological management includes a variety of lifestyle changes that do not involve medication, such as:

• • • Maintaining a healthy weight: Being overweight or obese can disrupt hormone levels and contribute to heavy bleeding. Maintaining a healthy weight through regular exercise and a balanced diet can help regulate menstrual cycles and reduce heavy bleeding.
    • Exercising regularly: Regular physical activity can help improve menstrual regularity and reduce heavy menstrual bleeding. Aim for at least 30 minutes of moderate-intensity exercise on most days of the week.
    • Managing stress: Stress can contribute to menstrual irregularities and worsen heavy menstrual bleeding. Engage in stress-reducing activities such as yoga, meditation, or deep breathing exercises.
    • Eating a balanced diet: Include plenty of fruits, vegetables, whole grains, lean protein, and healthy fats in your diet. Avoid excessive intake of processed foods, sugar, and alcohol, which can worsen inflammation and contribute to heavy bleeding. Also include iron-rich foods in your diet to prevent anemia from heavy bleeding.

Pharmacological management

Pharmacological management involves the use of medications to control menstrual bleeding. Some of the most common pharmacological treatments for heavy menstrual bleeding in adolescents include:

• • • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs like ibuprofen can help reduce heavy menstrual bleeding by decreasing the production of prostaglandins, which are hormone-like substances that play a role in menstrual cramps and heavy bleeding.
    • Gonadotropin-releasing hormone (GnRH) agonists: These medications work by suppressing the production of estrogen and progesterone, which can reduce menstrual bleeding. They are usually used for short-term treatment in adolescents who have severe menstrual bleeding and are not responding to other treatments.
    • Hormonal contraceptives: Birth control pills, patches, or intrauterine devices (IUDs) that contain progestin can help regulate menstrual cycles and reduce heavy bleeding. These medications work by preventing ovulation and thinning the lining of the uterus.
    • Progestin therapy: Progestin-only pills or injections can help regulate menstrual cycles and reduce heavy menstrual bleeding by thickening the cervical mucus and thinning the uterine lining.

The choice of medication depends on the underlying cause of the bleeding and you and your doctor’s preferences. Now we move on to surgical treatment options.

Surgical treatment options

Surgical treatment options for heavy menstrual bleeding in adolescents are typically reserved for extreme cases that do not respond to other treatments.

• • • Endometrial ablation: This is a minimally invasive procedure that uses heat or cold to destroy the lining of the uterus, reducing or eliminating menstrual bleeding. The chances of pregnancy are greatly reduced after endometrial ablation, and even if conception occurs, the chances of miscarriage and other problems are greatly increased.
    • Hysterectomy: This is the surgical removal of the uterus and is considered a last resort for treating heavy menstrual bleeding in adolescents. It is only considered when other treatments have failed, and the adolescent does not plan to bear children in the future.

Things won’t reach this stage for adolescents, so stay cool. These are options, and we wanted you to be aware of them, that’s it!

Managing heavy menstrual bleeding with RIO

A practical solution to heavy menstrual bleeding. RIO Heavy Flow Sanitary Pads are:

• • • Engineered for rapid absorption of blood as well as blood clots and gushes.
    • 3x more absorbent than your regular pads.
    • Equipped with standing guards and wings for double protection from stains and leaks.
    • Shaped like an hourglass for full-coverage and a snug fit.
    • Anti-bacterial, anti-odor and 100% free from sulphur, paraben, and artificial fragrances.

Hope you have a good experience with RIO!

Impact of heavy menstrual bleeding on adolescents

This condition can have a significant impact on adolescents – the girls who are still learning to live with monthly periods.

Physically, they are hit with fatigue, weakness, and dizziness due to blood loss. With blood loss, iron deficiency can cause chest pain, shortness of breath, rapid heartbeat, and pounding headaches. Living with these symptoms for more than 7 days straight can really take a toll on their body.

Emotionally, heavy bleeding can cause feelings of embarrassment, shame, and anxiety. The constant fear of blood dripping down or blood staining clothes in public can result in them isolating themselves. Heavy menstrual bleeding can also cause terrible mood swings and irritability due to the hormonal fluctuations, leading to feelings of frustration at the inability to understand even their own emotions and at the difficulty managing day-to-day activities.

Socially, adolescents may miss school due to the physical and emotional impact of heavy menstrual bleeding, resulting in poor academic performances and reduced self-confidence. They may also miss out on social events or avoid participating in activities they used to enjoy, to avoid embarrassment or discomfort. But worst of all, this condition can also impact relationships with family and friends, as adolescents may feel uncomfortable discussing their menstrual problems or may feel unsupported by loved ones who do not understand the impact of heavy menstrual bleeding.

All of this can be too overwhelming for adolescents.

How can you help?

Assuming you’re a caregiver looking to educate yourself on this condition, you’re off to a good start. Educate yourself to better understand what your loved one is going through and how you can support them.

Offer emotional support and reassurance that they are not alone in their struggles. Create a safe space for them to talk about their experiences without feeling judged or ashamed. Let them know that it is okay to talk about their menstrual cycle and that it’s just a normal part of life.

And finally, take them to the doctor. Heavy menstrual bleeding is not normal and isn’t something every adolescent goes through. See you in another blog!