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This site was archived on December 31, 2002 (Why? click HERE)
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 Vaginal bleeding which may cause concern

While on HRT
Postmenopausal
Heavy
Irregular

Menorrhagia aka "flooding"aka abnormal uterine bleeding
(Mostly) Personal posts
(authors retain copyright and responsibility for content)
How "heavy" is my bleeding anyway?
How much bleeding is dangerous?
"Bleeds I have known" - personal "bests" ;-0
coping with flash floods
  iron rich foods
caution re iron

While this is supposedly for physicians, seeing it's about a chart for self help I've included it with the personal posts

Extract from http://www.ices.on.ca/docs/fb1431a.htm
Physician Information for the Assessment of Menorrhagia

Menorrhagia is often defined subjectively as excessive or prolonged loss of blood on a regular cyclical basis. A more objective definition is menstrual blood loss of less than or equal to 80ml during the whole period. <1> However, the objective assessment of menstrual blood loss uses a specialized and time-consuming technique which is not feasible in routine clinical use.

Higham and colleagues have devised a self-administered scoring system. <2> This consists of pictorial charts that are completed on each day of the period. 

<snip description of development of charts and scoring procedure>

However, we suggest that the chart be used more as a self-assessment tool as opposed to a diagnostic test. 
------
 The chart in question may be seen at http://www.ices.on.ca/docs/fb1431b.htm



How much bleeding is dangerous?
Mary wrote 
I kept having episodes just barely under the "get yourself to the emergency room now" amount of bleeding, as measured by numer of tampons per time period.

I would be interested in knowing what the "number of tampons per time period" would be before one should head for the emergency room. I mean, is there actually such a measurment? 

Hi Mary and Company,  There is no specific number of tampons to be soaked before going to the emergency room.  First of all define tampon.  Regular, Super or Extra Super Cowabunga?  And which brand?  One or two at a time?   I have experienced flooding and it is really scarey when it happens.  I would put in two super tampons and an extra absorbant pad and in half an hour the blood would be running around the pad and down my legs.  Aside from being uncomfortable and inconvenient, a bleed through was predictably stressful and embarassing.  Blood represents life.  When you see it running out like that and you can't see the source of the bleed to apply pressure or know when it is going to stop, the only thought you have is to get help.  It depends on the circumstances, your knowledge of your personal history and your previous experience with bleeding as to what you will do.  If the doctor is available, you will call him/her and get instructions.  If the doctor is not available, you head to the ER.  I was lucky and the doctor was there for me, but by the time I saw him, the bleeding was diminished; so my feeling of emergency was also diminished.  Chances are that if you go to the ER sure that you are bleeding to death, you will sit for hours waiting for your turn to be seen and there will be little they can do for you.  Chances are the bleeding will slow down by itself and they will tell you to see the doctor in his office next day.  When these bleeds have happened to one over and over it becomes commonplace, but the first time it happens is the worst and most likely to find one going to the emergency room.  Just my thoughts after my experience. 

Cheryl 



 I'm 49 and for the past year have had heavier than normal periods but then the last 3 months I didn't have any and I was really glad. Now, I've gotten one again which has gone on up to 13 days with no sign of slackening off! All my life I've never had one past 5 days.  It is such a pain and I also have bad cramps with them and it is still heavy.  Has anyone else experienced the same thing. Any advice?  I do not want to go to any doctor!

Welcome to the wonderful world of perimenopause, Peggy, where the word "cycle" ceases to have any real meaning.

Many of us come into this time of life with the vague sense that we'll have "irregular" periods, maybe a few hot flashes and then no periods at all.

What nobody tells us is that "irregular" can mean anything from lighter, less frequent periods, to heavy, almost constant bleeding, to any combination of those things. It all fits within the realm of "normal," even when it's a royal pain in the ass. And it can last for several years before that last period which signals that we are fully menopausal.

I went through very much what you're describing about a year ago (although when I realized what was happening and thought back, it really began more than three years ago, when my usual 28-day cycle shrank to a still-regular 21-day cycle). I've skipped periods entirely, bled copiously with gross clotting for more than two straight weeks, spotted, had the occasional "normal" period, you name it. None of it is predictable, so I now carry feminine hygiene supplies with me everywhere I go, and try not to worry about it. 

It took me a while - and finding this newsgroup - to understand that as disconcerting as this is, it's normal. 

I understand your reluctance to see a doctor (I was terrified that mine would tell me I had cancer). But a good, thorough physical can be very reassuring, and I would recommend it. Some doctors are quick to push hormone therapy on their menopausal patients, so you might want to do some research on the subject so that you're prepared to make an educated decision rather than just taking whatever your doctor tells you to take. I can recommend Dr. Susan Love's Hormone Book, which ought to be available at your local library, for its common-sense approach to all these questions.
Pat Kight



Re: Heavy bleeding for the first time.

Verity, I had problems with continuous heavy bleeding for some months starting last summer and continuing through May. I too had moved and had several other stressors in my life, and was put on Premphase (estrogen and progesterone) with disastrous results - much more bleeding. It has gradually comee under control on a course of continuous Provera, in diminishing doses. I found, too, that once I started losing weight myproblems started to ease up. 

In my case, I had an endometrial biopsy (a relatively simple and inexpensive procedure that is performed in the doctor's office) to helprule out endometrial cancer. My gynecologist and I believe that my bleeding was a response to an oversupply of estrogen relative to my own progesterone levels. While I was bleeding, I found that it would be exacerbated byalcohol (as little as one glass of wine), soy products, and stress. Some of my worst episodes of bleeding, as I look back on it now, coincided with rail travel and public speaking. 

Your heavy bleeding is probably "normal" - that is to say, it happens to many of us in perimenopause. Try not to worry too much. Pamper yourself if you can manage it - take naps if your schedule will permit. Buy sanitary products in bulk and squirrel them everywhere. React with caution if your doctor suggests extensive surgery to stop the bleeding (as opposed to taking out a cancer); it may subside on its own or with temporary supplemental hormones. Keep in touch and we'll do our best to lend practical advice when possible, moral support as needed. 

"Abnormal bleeding" is often normal in perimenopause. Occasionally, it is truly abnormal and can be an indicator that something is seriously amiss. Any change in bleeding except the most gradual should probably be evaluated by a health care professional, although it is prudent for you to expect or demand a conservative approach in most cases. If you are soaking more than one pad or tampon an hour and it continues for any length of time; if you have a lot of pain (as opposed to transient pain as the result of passing a blood clot); if this is something out of the blue, by all means seek a health care professional quickly. 

Regards, 
[email protected] 



Re: Cutting down on (H)RT taken for heavy bleeding
[email protected] wrote: 
I'm about to cut my daily dose of Provera in  half. I haven't done any serious bleeding for six months now and I suspect I don't need all that hormone any more. Stay tuned for further developments.

Go Laura! As a fellow former heavy bleeder, I hope this works as well for you as it did for me. It was so exhiliarating to find that as I graduallycut out the hormones, I didn't need them any more. I wasn't happy about having to take any hormones, but felt that the choice of taking provera and estratabs for a few months was infinitely preferable to ahysterectomy. So...cautious use of hormones for several months & what a result: a state of no-bleeding-at-all and increased energy! Let's hope that the provera did its job of stabilizing things & getting you through what has to be one of menopause's most frightening symptoms.After you've had the chance to build back your blood iron, there's this amazing clarity and zest on the "other side." I'm sure you are consulting with your doctor, but just be careful to taper gradually.Good luck!



A personal history, philosophy, tips and hints
http://members.aol.com/lblanch000/meno/bleeding.html 
asd posted a list of iron-rich foods, which prompted me to think that it's probably helpful to know how rich is "iron rich." So I've put in some interpolations about the quantities of iron in these foods, from the old USDA food composition tables found in the back of one of the Adelle Davis books. I think the RDA is 15-18 mg/day for the menstruating woman. 

>Iron rich food:

> - organ meats: liver, kidney, heart
  • Chicken livers - 7.4 mg in 3.5 oz
  • Beef liver - 13.1 mg in 3.5 oz
  • Beef kidney, 13.1 mg in 3.5 mg
  • Beef heart - 6 mg in 3.5 oz
  • Calf liver - 14.2 mg in 3.5 oz
> - shell fish
  • Crab - .8 mg in 3 oz
  • Lobster - .6 mg in 3 oz
  • Shrimp - 2.6 mg in 3 oz
> - oysters
  • Oysters - 6.6 mg in 1/2 cup (6-8 medium)
> - lean meat
  • Chuck, pot roasted - 2.9 mg in 3 oz
  • Sirloin steak - 2.5 mg in 3 oz
  • Round steak - 3 mg in 3 oz
> - leafy green vegetables
[I only included the high-scorers]  > - egg yolks
  • 1.8 mg each
> - dried peas and beans
  • Lentils, 4.1 mg/1 c
  • Peas, dried or fresh, about 1.9 mg/1 cup
  • Green limas, 2.5 mg/1 c
  • Kidney, 4.6 mg /1 c 
  • Soybeans, 5.4 mg/1 c
> - dried fruits
  • Apricots, 4.1 mg/1/2 c
  • Prunes, 4.5 mg/1 c cooked
  • Prune juice (okay, not dried...) 9.8 mg/1 cup

  •  
> - dark molasses
  • 2.3 mg/1 Tablespoon
> - enriched bread and cereals
  • Looks to me like an average of .5-1 mg/serving
asd continues: 

 Iron deficiency anemia is usually caused by blood loss through illness, injury or hemorrhage and is aggravated by a poorly balanced diet that is often deficient in dietary iron, protein and vitamin B complex. A deficiency of iron has been cited as the commonest of all deficiency disease in humans. (Food, Nutrition and Diet Therapy - Krause)

asd 

This may be of help to those of us who are working our way through the problems of heavy bleeding and would like to keep our iron uptake high. I don't know how many of these dietary sources of iron also interfere with vitamin E absorption; perhaps someone else can offer guidance. 

I might add that the time I was bleeding heavily was the only time in my life that I found beef liver to be utterly delicious. The body's wisdom, I suppose... 

Regards, 
lblanch000 



"Low blood count"
People with Haemoglobin  counts of less than 8 are often symptomatic, and would usually require treatment because of symptoms. Treatment, however, does not usually involve blood transfusion as your body will always (providing you have a normal diet) replace the lost haemoglobin using its iron stores. If there are no iron stores because of chronic depletion then you need extra iron, eg. in tablet form. Some women require transfusion because they are still losing so much blood that it cannot be replaced in time by iron therapy (requires 1 week for every 1-2 units rise) (a doctor)


A caution, particularly for postmenopausal women:
Never take iron supplements without a demonstrated need for them which means a blood test and a workup to find the source of the low hbg if it's found. Iron deficiency anemia may result from excessive menstrual blood loss. It may also have other causes - slow bleeding elsewhere in the body esp. the GI tract, inability to absorb iron from food, a poor diet. Even when the existence of anemia has been established, good doctors won't order iron until they are certain the cause is not something other than excessive menstrual blood loss. It's easy to take toxic levels of iron. 

Also medicine is having a second look at the iron levels we currently consider normal, and some doctors are suggesting that lower levels of hemoglobin might be healthier esp. for the cardiovascular system. The healthier hearts of premenopausal women may be the result of lower iron rather than estrogen. Hbg levels are gender-normed with normals for women being several Gms below that considered normal for men. Once menstruation and regular blood loss stop, women's iron levels begin to creep up until they approach those of low normal men. It may be this increase in iron that increases women's post-menopausal risk of heart disease. Occasional blood donation has been shown to decrease the risk of heart disease in men and this theory provides a rationale  Terri 



 For more on iron see http://www.CyberDiet.com/foodfact/vitmins/ironnew.html

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 Vaginal bleeding which may cause concern

While on HRT
Postmenopausal
Heavy
Irregular
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