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Most women have menstrual bleeding that lasts about four to five days every month, with around 2 to 3 tablespoons of blood lost per day.
A period can be a draining experience for many women.
- Mood swings, bleeding, and rash that accompany periods may often cause exhaustion and irritability.
- Various conditions may affect the duration of your periods, which include stress, physical exertion, medication history, and conditions such as Polycystic ovary syndrome, thyroid imbalances, uterine growths (benign or cancerous), and pelvic inflammatory disease.
For most women, menstrual bleeding lasts about four to five days every month (21 to 35 days), and the amount of blood loss per day is small (two to three tablespoons). However, about one out of every five women has menorrhagia (heavy periods).
Criteria to diagnose menorrhagia (heavy bleeding) are as follows:
- Bleeding lasts for more than seven days
- Need to change pads or tampons during the night
- Menstrual flow with frequent blood clots (the size of a quarter or larger)
- Menstrual flow interferes with the daily routine
- Constant pain in the lower part of the abdomen during periods
- Tiredness, lack of energy, or shortness of breath
- Need to change pads or tampons nearly every hour
- Menstrual flow that soaks through one or more pads or tampons every hour for several hours in a row
Does COVID-19 vaccine cause heavy bleeding?
Although the relationship between approved vaccines against COVID-19 (Moderna, Janssen, and Pfizer-BioNTech) was not observed during clinical trials, many women have reported the following symptoms after taking the vaccine:
- Heavier bleeding in current or the next cycle
- Bleeding or spotting between periods
- Severe abdominal cramps
- Spotting and bleeding in postmenopausal women
Although there is no clear reason why COVID-19 vaccines may cause heavier bleeding, following the first or second dose, researchers at Boston University, Harvard Medical School, Johns Hopkins University, Michigan State University, and Oregon Health and Science University are currently investigating if such changes are linked to the COVID-19 vaccine or if they are coincidental.
Proposed reasons why COVID-19 vaccines may cause heavy bleeding in some women to include:
- The stimulated immune system due to the COVID-19 vaccine could introduce a pro-inflammatory state in the body that could affect the ovaries in the short term. This might in turn affect hormone production over the next one or two cycles, and women might have irregular or heavier bleeding while on their periods.
- An asymptomatic COVID-19 infection that coincides with the timing of the jab may cause increased bleeding.
- Stress-related to the pandemic affects your hormonal milieu.
Most specialists believe that such side effects (even if present) are temporary and will not affect uterine function or fertility in the long run.
- The pregnancy incidence in vaccinated and nonvaccinated groups during clinical trials conducted has been similar.
- In any case, the benefits of the COVID-19 vaccine outweigh the side effects in the long run.
- It is, therefore, essential to take vaccines as recommended.
Considering the omicron variant, vaccination and recommended booster doses are more important than ever.
Pregnant women should discuss with their gynecologist the vaccine suitable for their condition and the dosing schedule.
QUESTION
What is pelvic inflammatory disease (PID)?
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When menstrual bleeding is an emergency?
In most cases, you do not require a visit to the doctor in case of a heavy period. A day off from work, hydration, some hot water fomentation for pain and cramps, and a tablet of acetaminophen or ibuprofen work.
If you experience any of the following while you have heavy periods, you should seek immediate medical attention:
- Extreme abdominal cramps
- Nausea and vomiting
- Diarrhea
- Shortness of breath
- Chest pain
- Dizziness
- Fever
- History of blood disorders (thrombocytopenia, leukemia, or hemophilia)
- Medication history for blood thinners, warfarin, heparin, or aspirin
- Cancer (heavy menstrual bleeding can be an early sign of uterine or cervical cancer)
How will the doctor test me if I have heavy periods?
After a detailed history and physical examination, your doctor may want to conduct tests to determine the cause of heavy bleeding.
Although it is okay to have rare heavy periods one time in three to four months, constant heavy periods need to be investigated.
- Blood investigations: In this test, the doctor will collect and examine your blood sample for anemia, white blood count, platelet count, thyroid hormone levels, kidney function, liver enzymes, or bleeding/clotting time.
- Pap test: The doctor will perform this test with a special instrument. They will remove cells from your cervix (uterine mouth) and then examine them under a microscope to find out if you have an infection, inflammation, or changes in your cells that might be cancerous or precancerous.
- Ultrasound: This is a painless test that uses sound waves to see what your blood vessels, tissues, and organs look like.
- Endometrial biopsy: Your doctor may collect samples from the endometrium (inner lining of the uterus) to find out if you have cancer or other abnormal cells.
- Radiological test: The doctor will perform a computed tomography or magnetic resonance imaging scan to visualize uterine growths in case of doubts regarding their type (cancerous or noncancerous).
- Sonohysterography: It is a special type of ultrasound scan done after fluid is injected into the uterus through your vagina. This test lets your doctor look at your uterine lining. It can detect conditions such as endometriosis, adenomyosis, and pelvic inflammatory disease.
- Hysteroscopy: This is a procedure to look at the inside of the uterus using a camera to see if you have fibroids, polyps, or growths that might be causing bleeding.
- Dilation and curettage (D&C): This procedure (or test) can be used to find and treat the cause of bleeding. The doctor will scrape off the inside lining of your uterus. A D&C is a simple procedure often done in an operating room.
You do not have to live with heavy and painful periods. With the right management of underlying conditions, lifestyle modifications, medications, and (in rare cases) surgery, heavy bleeding during periods can be effectively managed.
Meanwhile, it is essential to keep a check on your hemoglobin if you bleed heavily and start iron and folic acid supplements if needed.
