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Health Issues for Women in their 40s

Our own Dr. Anna Kogan was featured in SFGate with an article about women in their 40s and the health issues they need to consider.

Menorrhagia, or Heavy Bleeding: What is your body telling you?

If you experience heavy bleeding, you might feel distressed or frightened. Sometimes, though not always, it can be a signal that something is amiss.

Many women do not realize they are experiencing heavy bleeding because it is a normal flow for them. Since heavy periods can lead to fatigue, pelvic pain, and anemia, it is important to consult your provider for support. 

He/she can help determine if there is an underlying cause, and offer guidance about Western and holistic therapies that can support your body’s health.


What is heavy bleeding? 

Every woman’s body is different, and there is a wide range of normal when it comes to women’s cycles. An average period lasts about five days,1 with a normal range of two to eight days.2 A typical flow is somewhere between 10 and 35 mL, and averages about 2 tablespoonfuls.  

As hormonal changes occur, a woman’s menstrual periods may vary. Heavy bleeding is quite common in perimenopause (a few years before periods completely stop), and perimenopausal women are most likely to report it.3, 4

In the U.S., between 5 and 10 percent of women report heavy bleeding to their doctors.5 A lot of women do not report it to their physicians either because they think that it is normal or because they are embarrassed. Over 10 million women are diagnosed each year with menorrhagia, the medical term for heavy bleeding.6 Menorrhagia is defined as a menstrual flow of more than 80 mL. That translates to period lasting seven days or more or soaks over 16 pads or tampons.3


What to do about abnormal bleeding

If you have concerns about your periods, consult your health care provider for support. He/she can help you determine whether there is an issue, and if so, what you can do. Your provider may run diagnostic tests to help learn more.

The course of action you choose will depend on what the cause is, whether it is affecting the quality of your life, your sexual relationship and your ability to work . Talk with your provider to explore your options.


What can cause heavy bleeding?

There are many possible explanations. Since heavy bleeding sometimes signals a serious health issue, it is important to consult your health care practitioner for support.

Some common reasons for heavy bleeding include:


Using an IUD for Birth Control

Some women with an IUD experience more painful, longer, or heavier periods. There are other IUDs, which contain and release a small amount of progesterone daily, that reduce the quantity and duration of bleeding, reduce menstrual cramps, and also provide effective contraception.

If you experience unusual bleeding, pain, abnormal discharge, or a fever after an IUD fitting, consult your provider right away.


Hormonal Imbalance

Two key hormones, estrogen and progesterone, regulate a woman’s cycle. These hormones cause the lining of the uterus to build up and then, during menstruation, to be sloughed off. If estrogen’s influence is unusually strong, the lining can become too thick. When this happens, bleeding can be very heavy as the thick lining is shed.7


A Cycle without Ovulation

You might have a heavy period if you did not ovulate during a cycle. Often, this is accompanied by a very long stretch between periods (more than 40 days).7 This happens to every woman occasionally.2

Your provider can help determine if there is an underlying reason why you missed ovulation, like hormonal imbalance or stress. If you are trying to conceive, your provider can help you to determine how to best support your fertility.



These are non-cancerous growths in the uterus. They are benign, and, on their own, are not generally cause for concern. About 30 percent of women get them by age 35.2 They may cause no symptoms or may be associated with menorrhagia and pelvic pain.2

The exact cause is unknown, but fibroids seem to be regulated by estrogen production. Fibroids tend to grow during pregnancy, and become smaller after menopause.2

Minimally-invasive treatment options are available. Because fibroids can lead to infertility and pregnancy loss, some women choose to have them removed.



Rarely, irregular bleeding can be a sign of cancer or pre-cancerous changes in the lining of the uterus. Women who have irregular bleeding after age 35 or 40 may need an endometrial biopsy ( a simple office procedure in which a sample of the endometrium is taken) to rule out cancer.



Some women experience irregular or heavy bleeding as a result of their inability to form clots due a variety of coagulation defects.


Complications from Pregnancy

Any woman in the reproductive age group who has any irregular bleeding should immediately do a pregnancy test. Urine pregnancy tests are highly reliable. If positive, they should consult their physician to make sure that it is not an ectopic/tubal pregnancy, since this condition can be potentially life-threatening. A very heavy period is a possible sign of miscarriage. If you are pregnant, or think you might be, consult your provider if you experience heavy bleeding.


Other Causes

Heavy bleeding may also emerge because of other medical conditions, inherited disorders, and certain medications. In general, these causes are rare.



  1. Creinin MD, Keverline S, Meyn LA. How regular is regular? An analysis of menstrual cycle regularity. Contraception. 2004 Oct;70(4):289-92.
  2. The Boston Women’s Health Book Collective. Our Bodies, Ourselves. New York, NY: Touchstone; 2005.
  3. Jerilynn C. For Healthcare Providers: Managing Menorrhagia without Surgery. Available at: Accessibility verified June 1, 2014.
  4. Warren M. The Need For Proper Diagnosis and Treatment of Menorrhagia. Menopause Management, November/December 2002.
  5. National Women’s Health Resource Center. Survey titled Majority of Women Do Not Seek Treatment for Health Condition Affecting 1 in 5, November 15, 2005.
  6. Centers for Disease Control and Prevention: Office of Women’s Health. Helping Women Understand Bleeding Disorders, Health Matters for Women Newsletter, Summer 2002.
  7. Mayo Clinic. Menorrhagia (heavy menstrual bleeding). Available at: Accessibility verified May 30, 2014.

Meet & Greet Dates for 2014!

If you aren’t sure where you want to have your baby, come meet our team of certified nurse midwives and obstetricians to learn about their philosophy of  personalized births for you and your family!

Register for one of these dates on our Web site.

March 11, 2014

May 12, 2014

July 8, 2014

September 22, 2014

November 11, 2014

Last Meet and Greet of 2013

We can hardly believe that 2013 is already starting to wind down. This will be our last gathering in 2013—stay tuned for our 2014 schedule. If you are thinking you may have a baby in 2014, please come meet our team. We have some new midwives on our team, too!

November 12, 2013

6 PM

St. Luke’s

3555 Cesar Chavez Street

Griffin Room, 1st floor

Sign up here!

Don’t forget our Meet & Greet next week!

Come meet the midwives and obstetricians that make up the St. Luke’s Women’s Center. Register on the CPMC Web site.

WHEN: Monday, September 16 at 6 PM

WHERE:  St. Luke’s Campus, 3555 Cesar Chavez Street, First Floor (Griffin Room) San Francisco


Delaying the Severing of the Umbilical Cord

There was an interesting story in The New York Times recently about a paper analyzing the benefits of delayed umbilical cord severing after birth. This has been standard practice among the midwives at St. Lukes Women’s Center, according to Emily Beck, CNM.

“We allow the cord to pulse out, meaning it has no more pulse in it,” she says. “This allows the baby to receive all of its own blood. Some studies have suggested reduced risk of anemia as benefit. Essentially, we allow nature to take its course.

Of course, if there is any risk of the mother or the baby being compromised they will clamp and cut the cord. “We monitor the situation to ensure the safety of the mother and the baby.”

Meet the midwives!

Come meet our midwives and doctors at our free Meet & Greet event. You will also get a tour.

Tuesday, July 23, 2013

6 PM to 7 PM

3555 Cesar Chavez Street, 1st Floor, Griffin Room

San Francisco, CA


Call 415.641.6911 to reserve your space!

Meet our team in July

If you would like to learn more about our midwives and about the unique experience at St. Luke’s, come to our meet and greet!

July 19, 2012
6 pm to 7 pm

Sign up here!

Meet our team!

Meet our team of certified nurse midwives and obstetricians at our next Meet and Greet. Register here or call 415-641-6911 to reserve your space

6 p.m. to 7 p.m.
Griffin Room, 1st floor
3555 Cesar Chavez Street
San Francisco

Tuesday, July 23, 2013

Monday, September 16, 2013

Tuesday, November 12, 2013


Allergy Medicines and Pregnancy

After our unusually warm winter, followed by a wet March, the trees, grasses and molds are in hyper drive, releasing spores and pollen into the air. With that, many people are starting to suffer from seasonal allergies. Even if you have never suffered from allergies, you may develop symptoms while you are pregnant. Other women find their allergies reduce or entirely disappear during pregnancy. If you are one of unlucky ones who has the classic symptoms – stuffy head, sneezing, itchy and watery eyes, coughing – you may wonder if it’s safe to take allergy medication to relieve your symptoms while pregnant.

Medications are graded by classes based on their level of safety for pregnant women and their fetuses. Class A is the safest and Class D has been shown to be harmful to fetuses. Allergy medicines, such as antihistamines (e.g. Benadryl), decongestants (e.g. Sudafed) or nasal sprays (e.g. Afrin), fall into Class B, meaning they are considered safe during pregnancy, although studies in humans may not be available or may only have included a small number of pregnant women.

If you suffer from severe allergies and have been taking immunotherapy injections with an allergist before you got pregnant, you should tell him or her that you are pregnant so s/he can monitor your dose.

Here are some suggestions that may relieve your allergy symptoms without any medications. You should always talk with your doctor or health care provider before taking any medications or using “natural” therapies.

Avoid triggers and exposure. Try to stay indoors and keep windows closed on windy days when pollen counts are high. Avoid activities like raking leaves. Ventilate moist areas of your home, such as bathrooms, if you have mold allergies. You may also want to consider using a HEPA filter in your heater, air conditioner and vacuum cleaner.

Exercise. Regular exercise can reduce nasal inflammation.

Rinse your nasal cavity. You may have seen neti pots or saline (salt water) rinse solutions in the pharmacy. You mix a solution of saline and distilled or sterilized water and inject it into one nostril as it drains out the other. Be sure to use distilled, filtered or previously boiled water. Never use water straight out of the tap. Follow the instructions carefully.


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