Heavy Periods Age 25

Susie Bauman is a 25 year old long time patient who was in the office several months ago for a routine physical exam, when she noted on her intake questionnaire that she was having trouble with heavy periods.

Her periods have always been regular, but used to last 4-5 days of moderate flow. Over the last 6 months, they have lasted 6-7 days, are heavier, and she’s having moderate menstrual cramps that she never had before.

She is 5”6” tall and weighs 210 pounds. She weighed around 140 pounds when she graduated from high school.

Her exam was normal, except for some facial acne.

I recommended several things for her, among them:
-Birth control pills
-Pelvic ultrasound scan
-Weight loss
-TSH and free T4.

The big picture on this patient is that she has gained a lot of weight over the last 7 years, and her weight is high enough now that it may be contributing to, or the cause of her heavy periods. All fat cells have the capability to convert steroid hormones of all types into estradiol, a weak estrogen. Although it is weak, if you have enough fat cell production, you can have enough estrogenic stimulation to actually cause some symptoms. In her case, the excess estriol was stimulating her endometrium, making it a lot thicker than it used to be when menstruation would hit. All other things being equal, the more estrogen priming before a period, the heavier and longer it will be.

The rationale behind birth control pills is that by suppressing ovarian function, her natural production of estrogen will be suppressed, resulting in somewhat less estrogen priming of her uterine lining before menses. This may not totally solve the problem, though, because she still has all of her estriol from fat and that will still be trying to proliferate the endometrial tissues. Still, this is a good place to start and see if simple birth control pills will rein in the heavy, crampy bleeding.

I wanted her TSH and free T4 evaluated to see if she might have an underlying hypothyroid problem. Thydroid problems are common among women and this could explain the very large weight gain she’s experienced since graduating from high school.

I recommended weight loss to her, through a combination of diet and exercise, as a good longterm solution to her menorrhagia and also out of general concerns for her health.

I recommended a pelvic ultrasound scan, because I was interested in knowing that her ovaries were normal and did not have a hormone-producing tumor within them. I wasn’t so concerned about the uterus, since at age 25, it was very unlikely that her heavy bleeding would be due to a mechanical problem such as polyps or fibroids, or due to an endometrial malignancy, which would be extraordinarily unlikely at age 25.