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Menstruation (your period) is a normal and necessary process for the human body – yet stigma around menstruation remains common. While it’s a completely natural and well-known process, menstruators often feel embarrassed or uncomfortable openly discussing their period and its symptoms or purchasing menstrual products. A nationwide survey of over 13,000 Americans between the ages of 19-48 conducted by Myovant Sciences and Evidation Health in 2019 found that about 1 in 5 female respondents do not feel comfortable talking about menstruation with their healthcare provider.[2,3] As a result, people with health conditions associated with menstruation may go undiagnosed, suffer in silence, and may not seek treatments to help their symptoms. Over 80% of female survey respondents also reported that they have experienced heavy menstrual bleeding or menstrual pain at some point in their lives. Abnormalities in your period like heavy menstrual bleeding may be signs of uterine fibroids – a condition that occurs in about 70% of menstruators by the onset of menopause.
What are uterine fibroids?
Uterine fibroids are noncancerous growths that develop in or on the walls of the uterus. There are several different types of fibroids, such as intramural, submucosal, and subserosal, which are defined by their location in the uterus. Estrogen contributes to their growth and research shows factors such as your genetics may also play a role in the disease. Black women are also more likely to experience uterine fibroids than white women. While not all people with uterine fibroids have symptoms, fibroids can cause heavy menstrual bleeding, pain, and anemia that may impact quality of life.
What is a heavy period?
Heavy menstrual bleeding, commonly known as heavy periods, can be defined as more than 80 mL in a cycle (approximately 1/3 cup – i.e., soaking through one or more pads or tampons every hour for several consecutive hours). Other signs and symptoms of heavy menstrual bleeding may include needing to wake up to change your sanitary protection during the night, bleeding for longer than a week, and needing to restrict your daily activities due to a heavy flow. Some menstruators also experience menstrual pain and cramps along with heavy menstrual bleeding. If you experience these or any other symptoms that feel abnormal, listen to your body and talk to your doctor.
When and how can you seek a diagnosis?
Accepting heavy menstrual bleeding and pain as “normal” or “just how things are” should not be the standard for how people think about their cycle. If you are experiencing pain or if you think your flow may be heavy, it may be worth discussing with your doctor. The first step in seeking a diagnosis is scheduling a pelvic exam. Depending on size and location, uterine fibroids may be found during these exams. If your doctor is unable to feel any fibroids through a manual exam, they may also use imaging technology, such as ultrasound, to identify them. Once these tests are complete, discuss your results with your doctor. If you are diagnosed with uterine fibroids, you can then work together to come up with the most appropriate plan for you.
What are your options?
Talking to your doctor about your symptoms, seeking a diagnosis and learning about your options for care are important steps you can take. Medication can be used to help treat some of the symptoms associated with uterine fibroids, including newer options such as gonadotropin-releasing hormone (GnRH) antagonists, which can decrease heavy periods associated with fibroids. Other treatment options include minimally invasive procedures, which may destroy the fibroids, as well as surgery, such as hysterectomy (surgical removal of the uterus) or myomectomy (removal of fibroids from the uterus). If you think you may have uterine fibroids, talk to your doctor about your specific situation and what treatment option may be right for you.
- Casola AR, Kunes B, Jefferson K, Riley AH. Menstrual health stigma in the United States: Communication complexities and implications for theory and Practice. J Midwifery Women's Health. 2021;66(6):725-728.
- Voices of periods: Hear their stories, help end period stigma. femaleforwardtogether.com. Accessed January 12, 2022. https://femaleforwardtogether.com/state-of-the-cycle/.
- First-of-Its-Kind Nationwide Survey from Myovant Sciences and Evidation Health Captures Impact of Menstrual Stigma and Symptoms. Myovant.com. Published October 17, 2019. Accessed January 12, 2022. https://investors.myovant.com/news-releases/news-release- details/first-its-kind-nationwide-survey-myovant-sciences-and-evidation.
- Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: A systematic review. BJOG. 2017;124(10):1501-1512.
- Uterine Fibroids. nichd.nih.gov. Accessed January 21, 2022. https://www.nichd.nih.gov/health/topics/factsheets/uterine.
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- Marsh EE, Al-Hendy A, Kappus D, Galitsky A, Stewart EA, Kerolous M. Burden, Prevalence, and Treatment of Uterine Fibroids: A Survey of U.S. Women. J Womens Health (Larchmt). 2018;27(11):1359-1367.
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- Heavy menstrual bleeding. ACOG.org. Accessed January 12, 2022. https://www.acog.org/womens-health/faqs/heavy-menstrual-bleeding.
- Borah BJ, Nicholson WK, Bradley L, Stewart EA. The impact of uterine leiomyomas: a national survey of affected women. Am J Obstet Gynecol. 2013;209(4):319.e1-319.e20.
- ACOG Committee on Practice Bulletins—Gynecology. Practice Bulletin No. 228: Management of Symptomatic Uterine Leiomyomas. Obstet Gynecol. 2021 Jun 1;137(6):e100- 115.