Abnormal Uterine Bleeding

Anovulation: the absence of ovulation. You may wish to view normal healthy reproductive physiology on my education webpage. 

Oligoovulation: a condition that causes irregular or infrequent periods.

Menorrhagia: period lasting > 7 days or very heavy, passing clots > than the size of a quarter. See "how do I measure volume of period flow" below. 

Metrorrhagia: bleeding at irregular intervals, particularly between normal periods, ie: intermenstrual bleeding. 

Perimenopause: the time period preceding menopause, which begins approximately 3-4 years prior to the woman's final menstrual period.

Menopause: defined as the permanent cessation of menstrual cycles, which is confirmed when the woman has not had a period for one full year. The average age is of menopause is 51.

Pre-malignant: a condition that may (or is likely to) become cancer. 

Malignant: a cancerous condition. 

Endometrial Hyperplasia: the inner lining of the uterus becomes too thick, which in some cases can be pre-malignant 

Iron deficient anemia: anemia caused by a lack of iron. Heaving uterine bleeding can predispose a women to iron deficient anemia. Symptoms of iron-deficient anemia include: weakness, fatigue, dizziness, heart palpitations, shortness of breath on exertion. 

Hypovolemia (hypo = low): low blood volume. Adequate blood volume is essential to keep your organs functioning normally. Symptoms of hypovolemia include: weakness, fatigue, dizziness, heart palpitations, shortness of breath on exertion. 

Hypovolemic shock: a severe state of hypovolemia, in which the vital organs of the body (heart, lungs, kidneys, etc) are inadequately perfused and suffer damage, at times irreparable (unable to be repaired). 

Blood Transfusion: is the process of transferring blood products directly into a persons' blood stream.  

Intravenous (IV) iron infusion:  the process of transferring iron directly into the bloodstream, which is a treatment offered to severely anemic patients. 

Endometrial Ablation: a surgical procedure where the endometrium is "ablated" (removed), which is a treatment option for abnormal uterine bleeding. 

Hysterectomy: removal of the uterus, which can be done transvaginally (through the vagina) or transabdominally (via an abdomenal incision). If the uterus is removed transabdominally, sometimes the cervix is left in place. 

Start by clicking on the image to the left and listen to a great 7-minute video by Rhesus Medicine, which will teach both patients and new NaPro providers about common causes for abnormal uterine bleeding. 

They use the mnemonic PALM COEIN to help you remember. 

P: Polyp – an abnormal but benign growth of tissue

A: Adenomyosis  – a condition where ectopic endometrial implants are found in the muscle layer of the uterus

L: Leiomyoma – a fibroid; a benign growth in the muscle layer of the uterus

M: Malignancy – a cancerous growth

C: Coagulopathy – a condition in which the blood's ability to coagulate (form clots) is impaired, such as as hemophilia and Von Willebrand disease.

O: Ovulation dysfunction – a condition in which a women does not ovulate normally, such as Polycystic Ovarian Syndrome Amenorrhea/ Functional Hypothalamic Amenorrhea, and perimenopause.

E: Endometrial – conditions that affect the endometrium, such as Endometriosis and Chronic endometritis 

I: Iatrogenic – caused by medical procedure or treatment, eg: Tamoxifen, 

N: Not Yet Classified

Please know NaPro Providers to not prescribe the birth control pill (mentioned briefly towards the end of this video). 

To the contrary, we believe the birth control pill is harmful to women physically, emotionally, and spiritually. We pride ourselves on taking our patients OFF hormonal contraception, finding the root cause of their symptoms, making a proper diagnosis and providing superior treatments for all of the conditions we treat. 

For more information about the spiritual harm brought  into the relationship via contraception, visit my  CrMS page, scroll to the bottom and read about SPICE. 

Most often an initial appt with a NaPro provider will be one FULL HOUR in length. Generally speaking, NaPro appts will follow a typical protocol. However, every individual is different and your situation may warrant a more expeditious process. Please know, the Creighton Model Charting is very important. Your CrMS chart will help direct your NaPro provider as to what diagnostic tests and imaging tests should be done and what treatment plan would be most appropriate for you, personally. For more detailed information about what a typical NaPro diagnostic evaluatin will look like, please click the button below. 

I will be asking you to tell me very specifically how much you are bleeding. An example of a "detailed flow" is: M, M, H, L, L, VL/B

TAMPON or PADS: 

• Very Heavy (VH): changing a full pad/tampon every 1-2 hours
• Heavy (H): changing a full pad/tampon every 3-4 hours 
• Moderate (M): changing a full pad/tampon every 5-7 hours
• Light (L): changing a full pad/tampon every  8-12 hours
• Very Light (VL): changing pad/tampon less than every 12 hours

MENSTRUAL CUP MEASUREMENTS

• Very Heavy (VH): 60 cc in a 24 hours
• Heavy (H): 40 cc in 24 hours
• Moderate (M): 20 cc in 24 hours
• Light (L): 10 cc in 24 hours
• Very Light (VL):  5 cc in 24 hours

**The Diva Cup comes in 20, 30 and 32 ml cups 32 being the largest but other cups may vary. 1 ml = roughly 1 cc 

Other important information about your flow: 

• Tail End Brown Bleeding (TEBB): brown bleeding at tail end of period. 
• Premenstrual bleeding: pink spotting or brown spotting at the prior to a full period starting. 
• Intermenstrual bleeding: bleeding between periods.