The ways that women experience menstrual periods vary from person to person. Symptoms may vary quite a bit and the intensity of those symptoms may vary from month to month.

Jade Elliott spoke with Leah Moses, CNM, Intermountain Healthcare, about uterine fibroids and endometriosis on this episode of the Baby Your Baby Podcast.

“Some patients describe their periods as barely noticeable, slightly uncomfortable, or that they just feel a bit off. Other patients experience significant cramping, bleeding, discomfort, bloating and/or headaches that prevent them from doing the things they want and need to do in day-to-day life. Most women fall somewhere in between. Symptoms and pain tolerance really vary,” said Moses.

Because periods typically happen every month for several decades throughout what are considered the “childbearing years” – from the time a woman starts menstruating until she’s completely in menopause – many women may feel like their period symptoms are normal because that’s all they know.

It’s important that women talk to their doctor or midwife about their period symptoms at their annual visit and let them know if they notice significant changes in their periods. Providers can explain what is normal and identify symptoms that might be related to underlying conditions. Keeping track of menstrual frequency, duration and flow amounts in a journal or on an app can be very helpful to track changes over time to help determine what is normal.

There are often emotional benefits for women when they talk to friends and family members about their period symptoms. Most can sympathize and relate to symptoms and compare notes to notice if something is unusual. Women should see their provider if they think their symptoms seem worse or different, have dramatically changed, or even just have a gut feeling that something needs to be addressed.

“Don’t just depend on your family or friends alone to give you advice, go talk to a provider. It may turn out your experience is in the range of normal, but identifying conditions that need attention is best done early. There may be some genetic similarities passed on in families, but that doesn’t mean those conditions are normal, or that you have to suffer. And family members or same-age friends can have a lot of variation in cycle bleeding and general health,” said Moses.

Women are often the main caregiver in their family and may not make time for formal healthcare and haven’t had an exam in several years. Many women don’t seek healthcare often, except during pregnancy or the occasional simple urgent care visit. It’s important to have regular annual exams outside of those big events or small crises.

When periods might get heavier

“The years when women may experience unusual bleeding patterns and sometimes heavier periods are during the bookends of life, or in other words, during the beginning year or so of starting periods and the final years—or perimenopause. During the middle years most of the time periods tend to regulate,” said Moses.

“For young women, the body is just getting used to menstrual cycles and experiencing a new flood of hormones. When shedding the uterine lining for the first several times, periods can be heavy. For older women no longer bearing children or breastfeeding, it’s not uncommon that as hormones change, periods vary and can sometimes get heavier,” she added.

Other factors that affect bleeding include genetics, number of pregnancies and overall health, as well as life changes month to month.

When to seek care for heavy menstrual bleeding

If symptoms of pain or bleeding are severe, or are not going away with home remedies and over-the-counter medications, contact a women’s health provider.

“If you’re bleeding so much you’re filling a regular sanitary pad in an hour, you need to be seen immediately. Heavy bleeding can cause women to become anemic or have low iron levels over time, or can be a symptom of something more serious, like fibroids, endometriosis, polyps, or malignancies,” said Moses.

A primary care doctor, an OB/Gyn or a midwife is a great place to start, then patients can be referred to other specialists as needed. Women who are experiencing severe, persistent abdominal pain or unusually heavy bleeding during their period should go to an urgent care or emergency room.

Common causes of painful periods and heavy bleeding

Two of the most common causes of painful periods and heavy bleeding can be fibroids and endometriosis. Other causes are polyps and malignancies.

Fibroids

Fibroids are non-cancerous tumors of muscular and fibrous tissues that can occur in other parts of the body, and can commonly develop in the wall of the uterus.

Uterine fibroids are the most common tumor of the reproductive tract. Approximately 40 to 80 percent of women have fibroids over their lifetime, however, most are small, asymptomatic, and not concerning.

Fibroids can occur in many locations, outside and inside the uterus. Depending on location and size, fibroids can create different symptoms of varied severity. Medical imaging is necessary to diagnose them. Certain sizes of fibroids and locations are normal, while others need medical attention. Fibroids can range in size from 1 mm to more than 20 cm (8 inches) in diameter or even larger.

Fibroids often appear during the childbearing years, and are most common between ages 30-40. Some women are relieved to know symptoms of uterine fibroids usually stabilize or go away completely after menopause as hormone levels decline.

Symptoms of uterine fibroids

Most fibroids are small and don’t cause symptoms or require treatment, other than annual observation. Larger fibroids can cause a variety of symptoms, including:

• Longer, heavier or more painful, frequent periods
  
•  Painful abdominal cramps
  
•  Bleeding between periods
  
• Boating or feeling of fullness in lower abdomen or abdominal enlargement
  
• Nausea
  
• Fever
  
•  Pain during sex
  
• Low back pain
  
•  Constipation
  
•  Frequent urination, inability to urinate or to completely empty the bladder
  

Side effects of fibroids

• Anemia from blood loss
  
• Miscarriage or Infertility
  

The causes of fibroids are unknown but could be genetic or hormone-related, specifically tied to estrogen and progesterone levels. Hormones are a big cause, and that’s one reason why fibroids can change in size. Imaging results can also vary during monthly cycles and over longer periods of time, so seeing the same provider could help track results and streamline care.

Risk factors

• Obesity – defined as 20% over healthy body weight
  
•  Heredity, or family history of fibroids
  
• Not having children
  
•  Early onset of menstruation younger than age 11
  
•  Late age for menopause
  
• Vitamin D deficiency
  
•  Poor diet, high in red meat or not enough fresh fruits and green vegetables
  
•  Alcohol use
  
• Race: Black women are more likely to have fibroids younger or more severe. Additional studies are needed in black and minority populations to more completely understand all the risk factors.
  

In general, fibroids can’t be completely prevented, but women can reduce their risk by maintaining a healthy body weight with a healthy diet and having annual exams.

Treatment or monitoring of fibroids may be needed

Depending on location and size of the fibroid, treatment may or may not be needed. They are not usually dangerous, but it can vary from person to person. If women have small fibroids, it’s a good idea to make a plan for how often to monitor them.

It’s ok for women to get pregnant if they have uterine fibroids, but they should be especially conscious to have regular prenatal care with proper imaging as there are some risks of pregnancy complications, such as placenta abruption, fetal growth restriction or preterm birth.

Endometriosis can cause painful periods and heavy bleeding and affects 1 in 10 women

Endometriosis can be a devastating, often painful condition when the lining of the uterus or endometrium grows outside of the uterus. It affects 1 in 10 women in the U.S.

“In endometriosis, the displaced tissue grows, thickens, breaks down and bleeds, but then has no way to exit a woman’s body and is trapped, and can irritate surrounding tissue, causing pelvic pain, scar tissue or cysts,” said Moses.

Common symptoms of endometriosis

• Painful menstrual periods
  
• Pain with sexual intercourse
  
• Pain with bowel movements or urination
  
• Excessive bleeding during or between periods
  
• Fatigue, diarrhea, constipation, bloating, nausea especially during periods
  
• Infertility
  

When to see a doctor or midwife

If women experience more than one of these symptoms, or even if just one symptom is very severe, they should see their provider. Severe pelvic pain or heavy bleeding can impact a woman’s daily function and possibly her long-term health.

Risk factors for endometriosis

• Starting menstruation at an early age
  
• Going through menopause at an older age
  
• Heavy menstrual periods
  
• High estrogen levels
  
•  Low body mass index
  
•  Family history of endometriosis
  

The causes of endometriosis remain elusive. Hormones or immune system factors that affect the lining of the abdomen can sometimes play a role, as well as scar tissue from abdominal surgery.

Early diagnosis is important because endometriosis can be complex and difficult to treat

Early diagnosis may result in better management of symptoms. Women should see a specialist if their symptoms are severe and other remedies aren’t working.

Start with low intervention help. Keep track of symptoms over time. Note what helps or makes them worse and keep track of the bleeding or pain pattern. The more accurate data women give to their healthcare provider, the better they can get help ruling out other issues or determining if a specialist is recommended.

Treatments can include a series of injections over a few months or more recently, oral pills. There are also various surgical options.

Some endometriosis is microscopic in nature, so it can’t be seen. Trying out medication can help determine if it’s endometriosis and treat what can’t be seen. Endometriosis can go hand in hand with infertility, many women will pursue treatments that can preserve fertility.

There are different schools of thought on how to surgically treat endometriosis. There is very precise excision surgery to remove what can be microscopic endometriosis. Other surgical options are the less-invasive laparoscopy or major surgery, such as a hysterectomy.

If a woman believes she has endometriosis, it’s very important for her to bring as much accurate information about her symptoms to her provider early to determine more about her case and refer her to a specialist for care.

For more information visit:

https://intermountainhealthcare.org/services/womens-health/

The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.