Heavy Periods

Hi-
I am 30 years old, have had two children (vaginal deliveries - a 1 year old and 3 year old). My periods have been very heavy. My cycle is 28 days if I count from the first day of heavy bleeding- however I spot for 3 days before the heavy bleeding begins. Once the heavy bleeding begins I bleed for 7 days (4 of which are very heavy) I use the Diva Cup (menstrual cup) because my periods are so heavy tampons aren't absorbent enough. Because I use the Diva Cup, I know that I bleed over 100 mls each period.  From the time I start spotting to the time I stop bleeding is typically 10 days. I cannot go on hormonal birth control because of other health issues. I had a transvaginal u/s to check for cysts (I also have pain in the area of my right ovary) and it was fine- no cysts, no fibriods.  What could be the cause of the heavy bleeding, and should I be concerned?

Thank you!

[Elaine Brown, MD]

Hi!
I'm glad that they checked you for fibroids, because that was my first thought.  Another possibility is an endometrial polyp, but that should show up on your ultrasound as a thickening of the lining.  When someone has "mini-hemorrhages" and the work up is negative, we often suspect adenomyosis.  This is a form of endometriosis.  The abnormal endometriosis implants form within the muscle wall of the uterus, and can make it enlarged, and irregular.  Adenomyosis can also cause pain.
I have two thoughts for you:
Have you considered the Mirena IUD?  Those really work, and because the progesterone is only dispersed locally within the uterus, you don't have to worry about systemic side effects ( like blood clots, etc).  The other possiblity is an endometrial ablation.  Since you only have two kids you may not be ready for that yet--you should be finished with your family before having an ablation--but it could really slow down the flow.
One thing you absolutely should do is take a multivitamin with iron.  Anemia could make it very hard to keep up with those litte ones!
Good luck!
Dr B