Vagina or Niagara?
April 18, 2012 6:57 PM   Subscribe

Today I learned the average volume of menses produced during one menstrual period. This led me to realize my periods are abnormally heavy. I'm not anemic. Are there other things I should be worried about?

I found a statistic that said most women produce about 30-35 ml of fluid during their periods. I was curious where I fell and used my menstrual cup to track approximate volume. In one heavy day I am losing well over 100 ml! My period normally has one to two heavy days with a few medium and light days on either side (7-8 days total).

My period has always been like this. I am in my mid-twenties. I am not overweight or androgenic. I sometimes get cramps and backaches but they are rarely unmanageable. Energy stays OK. I have had a copper IUD for more than a year, but the only change to my cycle was the addition of a few light spotty days. Iron levels are normal.

That said, is there anything I should I be worried about or keep an eye on? I never realized my "heavy" was someone else's "hemorrhaging" and it has me concerned.
posted by Hey nonny nonny mouse to Health & Fitness (18 answers total) 4 users marked this as a favorite
What I had heard is that most women lose about 30-35ml of BLOOD. But this ends up being an awful lot more fluid because it is diluted with mucus and other secretions.

I think my heavy is about the same as yours (I also use a menstrual cup) and it is much lighter than it used to be in my teenage years when my doctor WAS concerned about how heavy my periods were.
posted by lollusc at 7:02 PM on April 18, 2012 [4 favorites]

Are you sure you're not anemic (i.e. -- blood test recently?).

I believe there is a wide range of variation on either side of the 30-35 ml mean number -- but still 100 ml day sounds like quite a lot. And using a menstrual cup -- you certainly have an accurate measure.

If it were me, I would schedule a visit with my OB/Gyn just to rule out some stuff -- but it may well be nothing.

(I think the 35mL is total flow, btw not just blood.)
posted by pantarei70 at 7:08 PM on April 18, 2012

Endometriosis is a possibility. Every gynecologist I've seen has been pretty sure I have it (the only way to diagnose is with laproscopic surgery, though, so I'm not a confirmed case).

My symptoms: RIDICULOUSLY heavy periods. I wasn't using a menstrual cup back then, but I'd go through a super-plus tampon in under an hour on the first day, and generally went through a whole 40 box every period. I generally had to stay home from school for the first day or two because I would have to get up and run to the bathroom every forty minutes. Also, RIDICULOUSLY bad cramps. Like crazy, doubled-up, unable to walk bad.

Things got much, much better for me once I went on HBC, and now I'm down to what I figure is probably a "normal" period, with "normal" flow and moderate cramps. Things are also much, much easier since I started using a divacup. I look back on those years before I started HBC and I can't believe how much agony I endured unnecessarily.

But honestly, if you're doing just fine otherwise, I wouldn't even give it another thought. (Though definitely run it by your doctor just to make sure.) But if you've got a good iron count and you don't feel like you're totally dead on your feet, energy-wise, I would just chalk it up to being One of Those Things.
posted by phunniemee at 7:09 PM on April 18, 2012

If you're willing to switch to tampons for a few periods, the rule of thumb is if you go through more than one an hour, that's a sign of a problem. That might give you some perspective (or at least a yardstick that your GYN can use next time you go in for your annual).
posted by elizeh at 7:09 PM on April 18, 2012

This seems like a good site for info. They say:
"Officially, flow of more than 80 ml per menstrual period is considered menorrhagia." "However the amount of flow was highly variable—it ranged from a spot to over two cups (540 ml)" (Talking about what 'normal' is)

W/r/t dealing with it, it says that ibuprofen decreases flow by 25-30%. They also recommend to treat blood loss with extra fluid, salt and iron.
posted by travelwithcats at 7:11 PM on April 18, 2012 [1 favorite]

I never realized my "heavy" was someone else's "hemorrhaging"

"Hemorrhaging" per my GYN (and apparently elizeh's as well) is going through a super or ultra tampon in less than an hour, or overflowing a menstrual cup in two hours or so.

Talk with your GYN about it, but it might just be your normal. Different uteruses have differently thick linings and shed differently. On the other hand, your GYN might want to evaluate you for endometriosis.

My own singular data point is that for most of my life as a menstruating person, I went through an ultra tampon in two to three hours, and had to sleep with an ultra tampon and ultra maxi pad to avoid staining my sheets. This was just my normal; I was evaluated for endometriosis and fibroids, with no sign of either.

Then all kinds of wacky things happened to me in my mid-40s when I began perimenopause...but that's another story. Your normal may just be a relatively heavy flow.
posted by Sidhedevil at 7:15 PM on April 18, 2012 [1 favorite]

You might want to find an OB-GYN who is willing to give you a transvaginal ultrasound to check for fibroids, which can cause heavy bleeding. They can be "silent" or largely symptomless for years but if you have them, it's a good idea to keep track of their rate of growth with an annual ultrasound. That way, you'll know if they start growing more rapidly and might need to be removed, and can explore the less invasive (outpatient) removal options. (Once they're quite large and/or numerous, or if they're located outside the uterus, you start getting into surgeries that require hospital stays.)
posted by artemisia at 7:50 PM on April 18, 2012

Yeah, actually I revise my comment to suggest you see your doctor. I didn't read the bit where you said you often had two heavy days per period. I was interpreting "a heavy day" to mean "occasionally", i.e. sometimes during a period you might have one day like that. That's what I meant for me when I said my heavy was like yours. If I was having those heavy days regularly and several days in a row, I'd be more concerned.
posted by lollusc at 8:00 PM on April 18, 2012

Response by poster: I'm generally emptying my menstrual cup every 2 hours on my heavy days, and I've never gone without a pad whether I'm using a cup or a tampon. I have never used any tampons except super or ultra because there wasn't a point.

I did not realize fibroids don't always cause pain! I figured it could not be that or endometriosis because I do not have the kind of crippling cramps phunniemee describes. I will ask the doctor about that.
posted by Hey nonny nonny mouse at 8:19 PM on April 18, 2012

Response by poster: Oh, and yes, my "heavy" days happen 1-2 days during every period. My period is usually something like light-light-heavy-heavy-medium-medium-light followed by spotting for days and days (the spotting is courtesy of the copper IUD).
posted by Hey nonny nonny mouse at 8:21 PM on April 18, 2012

Another vote for beiNg evaluated for fibroids. In my case, a rogue fibroids busted out of my uterus and tapped into a blood vessel. Volume went from trickle to gusher but the surgical techniques to fix same are much improved, eg cauterization. You'll feel better if you get a medical opinion. Keep a period diary to improve your ability to describe matters in quantifiable terms and to demonstrate to the doc that you're not exaggerating.
posted by carmicha at 8:22 PM on April 18, 2012 [1 favorite]

Definitely get it checked out, but this might just be your normal (as it was mine). It's good to rule out endo and fibroids.
posted by Sidhedevil at 9:42 PM on April 18, 2012

IANA physician.

You should have a chat with your doctor - although the studies are small and mostly old and very full of white ladies and largely hospital-based rather than community-based, the "normal" woman loses about 70 mL of fluid per period, about a third to a half of which is blood. As noted, the clinical definition of menorrhagia (abnormally heavy menstrual bleeding) is 80 mL of blood over the whole period, which seems to correspond to around 160 mL of fluid. There's a lot of variability in fluid volume in the studies, but the volume you're reporting is pretty high. It's reassuring that your blood counts are okay, and maybe this is just the way you are, but there's also some (treatable) health problems that can cause heavy menstrual bleeding. Don't let it freak you out, but get it looked after. (And stay away from Dr. Google. That guy thinks everyone has cancer.)
posted by gingerest at 11:03 PM on April 18, 2012 [3 favorites]

You're saying your iron levels are normal, but does that include serum ferritin? This is a molecule that reflects longer-term iron reserves in the body, and is not ordinarily tested for.

After I had the copper IUD put in my periods began to resemble yours in volume and pattern, where previously I bled pretty lightly and never needed a super tampon. This has not improved five years later.

I had my serum ferritin level checked about three years into it at my own initiative as I was experiencing a lot of hair shedding. I discovered it was incredibly low, in the single digits, whereas my hemoglobin was fine. The doctor gave me iron supplements and this halted the hair loss in about four months but my ferritin is very slow to normalize. Last time I had it checked I believe it was in the 40s, a whole year after I started supplementation.
posted by Dragonness at 11:14 PM on April 18, 2012

I have (or had, really) endometrial hyperplasia and was having extremely heavy and long periods due to it. Mirena made it all better and got rid of the hyperplasia. I would definitely get this checked, as there is no reason you should have to deal with that much bleeding.
posted by SuzySmith at 2:18 AM on April 19, 2012

The best medical advice that I ever got when I was wavering on the edge of "[foo] hasn't ever happened to me before, but it's apparently normal for some people, should I be worried?" is that "there's normal, and then there's normal for you." Meaning, that "average" figure you found includes a wide, wide range of volumes, from a lot of individual women, each of which was perfectly healthy with whatever volume of blood she menstruated each month even though they were all wildly different.

See your doctor if you're concerned; but there's a possibility that your doctor will check you out, find that your iron levels are normal and you have no fibroids, and conclude that this is just how you're wired.
posted by EmpressCallipygos at 5:57 AM on April 19, 2012 [1 favorite]

Actually, let me elaborate on this a little.

If you have always for your entire menstruating life been basically like this, and you are otherwise healthy (i.e., you have decent amounts of energy and you don't get sicker with any more frequency than you usually do), then chances are very strong that "this is just how you're wired" is what your doctor's going to say.

But if you have always been like this and you get sick a lot more often than everyone else around you does and you always feel pretty tired, or you only just recently started in with the heavier periods when before it was always pretty light, that is more so of an indicator that "yo, something weird's going down here."

A single statistic alone (i.e., "the volume of blood shed during a period") is only one of a ba-squillion things to take into consideration when you're figuring out whether you're "healthy". Energy level, consistency of that statistic, overall health, diet, and a host of other things all contribute to the picture of whether you're healthy. What you're doing by looking at that one fact ("my menstrual output is higher than the statistical average") is kind of like looking at a single puzzle piece and projecting what the entire rest of the jigsaw looks like ("Oh, this bit here looks like it could be a tooth, I bet this is an alligator!"). You need to look at more puzzle pieces to be sure still (".....Oh, no, wait, it's the top of a sailboat.")
posted by EmpressCallipygos at 7:11 AM on April 19, 2012 [1 favorite]

> I have had a copper IUD for more than a year

Have you considered switching to a Mirena IUD?
posted by The corpse in the library at 9:30 AM on April 19, 2012

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