152. Floodgates

Early in his career, one my colleagues remembers greeting with mother-in-law with the standard, Hello, how are doing,"  expecting a return, fine, and how are you?

Instead, she replied, "the floodgates have opened," leaving him a little confused.  He later realized--perhaps with the help of his wife, that she was referring to the onset of a heavy period.

Like most phenomenon, menses follows a bell curve.  So though most women may describe a 4-5 day flow, a small group may experience 2 days of light bleeding, and an equal group on the other end of the curve may have 7 days of heavy flow, enough sometimes to keep them home for a day or so.

Lindsay has been bleeding for three weeks, never like this before and with no apparent reason.  She has lost about half of her blood supply. As a healthy 23 year old, she is able to tolerate this loss to a degree.  She can walk around but has a strong headache and could not deal with her job where she stands most of the day

If the bleeding stops and she tolerates iron supplements, her level could be back to normal within a couple of weeks.  But she has been offered a blood transfusion because another few days of heavy bleeding could lead to a life-threatening level. That would allow her to return to work. A temp worker now, she wants a full-time position and is worried that taking time off now (which she would have to do for a several days if she does not received a transfusion) would jeopardize this advancement. She says yes to a transfusion.

So we stopped the bleeding with intravenous estrogen and gave her two units pints of blood. The average adult has 10-12 pints of blood, so while two units will not put her pack to normal, it will take her out of the danger zone.