Sep 14, 2017

Dr. Jones: Horrible periods are the burden of being a woman, right? But sometimes, really heavy periods are a sign of something serious, and you should get help. This is Dr. Kirtly Jones from obstetrics and gynecology at University of Utah Health, and this is The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Well, as part of blood cancer awareness, we are looking at what could be signs of cancer that should seek medical attention and evaluation. Although heavy periods are common and there are many causes, some heavy periods can be a sign of blood cancer.

Recently, a study of 2,000 pre-menopausal women with leukemia revealed that 1 in 10 had heavy vaginal bleeding. For most of those women, they had heavy vaginal bleeding, heavy periods, for the months leading up to their diagnosis of leukemia. But other symptoms, such as fatigue or easy bruising or a fever, brought them to the doctor. But for about 1% of them, this was bleeding. It was this bleeding that brought them to the diagnosis of leukemia.

Although leukemia is a cancer of white blood cells, when the white blood cells multiply abnormally, they take over the bone marrow and displace the cells that make red blood cells. And more importantly, in this case they can replace the cells that make platelets. Platelets are these magic little pieces in our blood that help us make a clot.

Now, complicating this problem of low platelets in some blood cancers is that chemotherapy for leukemia often wipes out blood cells, good blood cells and bad blood cells, so that chemotherapy itself leads to the low platelets and heavy vaginal bleeding. Usually, though, the medical team knows about this risk in advance and gives women medications to stop their periods before chemotherapy.

Low platelets, or platelets that don't work is, is a common cause of heavy vaginal bleeding. It's one of the most common causes for vaginal bleeding that requires transfusion in teenagers.

Although leukemia can be a cause of low platelets, there are other blood problems that can cause low platelets, such as antibodies to platelets, called autoimmune thrombocytopenia, a big word, but when you break the word down, the autoimmune means that you're making immunities or antibodies to yourself, and thrombocytes are the cells that make thrombi, or clots, those platelets. And penia means you don't have enough of them. So, autoimmune thrombocytopenia. A blood test that shows low platelets will lead to more tests that can find out the cause and help with treatment.

So what is heavy menstrual bleeding? Women put up with a lot, and are often embarrassed to seek help, and figure that heavy periods are just a woman problem. Soaking more than two extra heavy pads or tampons each hour for several hours is too heavy. Passing clots bigger than a quarter for part of your period is too heavy. And but, of course, if you can't clot because you don't have enough platelets or clotting factors, then you won't clot, and that wouldn't be a sign. But anyway, heavy bleeding that's soaking through your protection for hours at a time is too heavy.

Of course, enough bleeding that you're now dizzy when you stand up means that you need to get help today. There are many causes of heavy menstrual bleeding, and some of them are part of a serious underlying medical problem. If you or your daughter or granddaughter or a friend have really heavy menstrual bleeding, you should get an evaluation. If that problem is in a young girl, she may be afraid to bring it up because of embarrassment or because she doesn't want a pelvic exam. In fact, for young women, the evaluation is usually by blood tests, and if a look at the uterus is necessary, ultrasound can be used.

For older women, the problem-causing heavy bleeding is more likely to be a uterine problem, such as uterine tumors, but everyone with really heavy periods gets an evaluation of their blood and their platelets and their clotting factors. Sometimes heavy vaginal bleeding can be a sign of liver or kidney disease, and other blood tests can be helpful.

Be aware that very heavy periods can be a sign of more than just a female problem and get help. Getting the right diagnosis can help with the treatment and make your periods better. And it may save your life. Thanks for joining us on The Scope.

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