As females, athletes, advocates, and educators, we’ve been in the trenches of navigating what should be a straightforward conversation with our healthcare providers—especially when it comes to our bodies. But let’s be honest: we’ve been exactly where many of you are now, unsure what to ask, what’s acceptable, and what the possibilities even are. We didn’t always have the tools or experience to guide us in those moments. However, we did know enough to want to pursue a greater understanding, which is why we keep seeking more knowledge in different educational circles—not just to repeat information, but to truly understand it and apply it not to just a population but to the individual we are working with directly.
Sadly, many women view menstrual bleeding as more of an inconvenience than a vital sign, report card of health, let alone health issue; as long as it’s not debilitating, they push through and ignore it. And why wouldn’t they? Too often, physicians, friends, or family members downplay these concerns, leaving us to feel as though we’re overreacting or wasting someone’s time. If someone who is of an authority (even a friend who is held in high regard) brushes it off as “normal” or “nothing to worry about,” many will walk away and keep managing, with an unsettling feeling that something’s being missed.
You won’t find ageism, sexism, or a vilification of Western medicine here; yes, there are challenges, and every field has its shortcomings, but that’s not our focus here at Fortify Health Coaching. But what if we empowered women through education? Instead of feeling dismissed or uncertain, they could actively participate in their own health decisions. With knowledge, they would no longer be passive recipients of care; they would become true partners in the process. This doesn’t mean undermining a provider’s expertise but engaging in a dialogue where women can express their concerns, ask for clarification, and collaborate on decisions aligned with their personal health needs and goals.Our mission is to equip both coaches and clients to have informed, constructive conversations with those whose life’s work is to help us stay healthy especially during times that go beyond foundational interventions (yes, you still have to work on these things).
As an example, I once worked with a client who thought if her period did not soak through a super tampon, heavy menstrual pad and her clothing it was considered ‘light’. On an entirely different perspective I have also had clients beginning hormone therapy panicking about breakthrough bleeding stopping their medication because a TikTok influencer said they should stop them immediately because hormones weren’t ‘natural’. I want to stay on topic today as this last point requires a much more thoughtful discussion but it was a noteworthy different example. If you have not checked out our resource How to Improve Your Hormone Therapy Experience, here is your call to action.
Empowerment Through Education and Shared Decision-Making
Women deserve more than a passive role in their health journey. For some, taking a more hands-off approach might be a choice—but that choice should be informed. Education empowers, and with knowledge, women have options. They can make health decisions that feel right for them, understanding that they’re more than just along for the ride.
Unfortunately, what women know about their health is often shaped by what they hear from others—their friends in school, coworkers, and family members. These shared experiences build a kind of folklore about what is “normal.” But how much of this is truly factual, and how much is based on someone’s perception of their own health, passed down until it becomes a distorted standard? Are we normalizing symptoms that shouldn’t be normalized? Are we normalizing silent suffering?
As we open up this dialogue, it’s crucial to differentiate myths from truths and cultural norms from medical standards. Let’s discuss what abnormal bleeding is and how important it is not to brush off these signs but to investigate them thoroughly. While some instances of irregular bleeding may be isolated or situational, chronic or persistent abnormal bleeding is rarely benign and requires careful attention.
What Is Considered Abnormal Bleeding?
Understanding what is “abnormal” versus “typical” menstrual bleeding is essential for health professionals and clients alike. We have a full menstrual cycle checklist HERE. Here’s a quick breakdown:
Extended Duration: Bleeding that lasts more than 7-10 days is considered prolonged and warrants further evaluation.
Spotting Between Cycles: Light bleeding or spotting outside of the typical menstrual period can indicate hormonal imbalances, uterine abnormalities, or other health concerns.
Heavy Flow: A flow that significantly interferes with daily activities or requires frequent tampon or pad changes (more than every 1-2 hours) may be a sign of heavy menstrual bleeding, potentially pointing to underlying conditions like fibroids, endometriosis, or coagulation issues.
Frequent Daily Spotting: Spotting on most days, regardless of cycle stage, is not typical and often requires medical evaluation to determine the cause.
Abnormal bleeding can sometimes signal underlying health conditions, which makes it essential to explore possible causes for accurate diagnosis and effective management. By understanding what constitutes “abnormal” bleeding, we’re better equipped to recognize when further action is needed.
Causes of Abnormal Bleeding
The causes of abnormal bleeding are varied and can involve multiple systems within the body. Here are just a few examples (this is not an exhaustive list):
Hormone Implications: Conditions like PCOS, thyroid disorders, and perimenopause can lead to irregular bleeding. Low progesterone, elevated growth hormone (Although rare, elevated growth hormone can impact menstrual regularity and bleeding patterns by influencing insulin-like growth factor (IGF-1) and reproductive hormone interactions) , high prolactin, etc.
Structural Abnormalities/Conditions: Issues like fibroids, polyps, granulosa cell tumors of the ovary, or adenomyosis (where the inner lining of the uterus breaks through the muscle wall) are common culprits of irregular bleeding.
Medications and Supplements: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), blood-thinning medications, contraceptives, changes in hormonal therapy/menopause hormone therapy (and any other hormonal intervention) may influence bleeding irregularities. Lastly, we must mention specific herbal supplements may exacerbate bleeding irregularities and should be considered when evaluating present need.
Bleeding Disorders: Coagulation Disorders including but not limited to Von Willebrand Disease: This inherited bleeding disorder impairs blood clotting and can result in prolonged or heavy bleeding, including menstruation.
Lifestyle Factors: Excessive exercise, alcohol, stress, rapid weight changes, or restrictive diets can also impact hormone levels and, subsequently, menstrual patterns.
Investigating Abnormal Bleeding: Tests and Procedures
When clients present with abnormal bleeding, it’s crucial that healthcare providers employ a thorough diagnostic approach, which may include:
Blood Tests: These can assess hormone levels (estrogen, progesterone, prolactin, testosterone, insulin, thyroid hormones, etc ) and other markers of systemic health, such as coagulation factors.
Ultrasounds and Imaging: Transvaginal ultrasounds provide a clear view of the uterus and ovaries, helping to detect abnormalities like fibroids, cysts, or polyps.
Biopsy: In certain cases, an endometrial biopsy may be necessary to rule out malignancies, particularly if there is concern about endometrial cancer.
It’s worth noting that not all healthcare providers will pursue these tests immediately. This is 100% contextual. Some may suggest a “wait and see” approach, while others may not fully recognize the importance of a patient’s concerns. Here, we can support our clients by explaining what these tests are, why they might be beneficial in their specific situation, and encouraging them to advocate for a comprehensive evaluation.
Closing Thoughts: Advocating for Thorough Testing and Informed Care
Understanding correlations and symptoms is empowering for both clients and coaches. As key members/collaborators, we play a key role in supporting clients as they seek answers, whether that means encouraging them to ask for thorough testing or exploring the possibility of a second opinion.
Sometimes, this might mean helping a client consider an out-of-pocket cost for testing if their insurance doesn’t cover it or exploring alternative healthcare providers who specialize in women’s health. As coaches, it’s our responsibility to provide clients with information that enables them to make educated decisions. Collaborating with healthcare providers (if the client is open to it) ensures that their care is comprehensive and that all potential causes of their symptoms are investigated.
Abnormal bleeding is often misunderstood and can easily be brushed aside. But as health professionals, we can advocate for a different approach—one where women’s symptoms are taken seriously and where they feel equipped to seek out the care they deserve. By educating clients on what abnormal bleeding can indicate and empowering them to ask for the right tests, we can help them gain control of their health journey.
Empowerment is about more than just knowledge; it’s about equipping women with the confidence to advocate for themselves, make informed choices, and collaborate actively in their healthcare. When we give women the tools to engage fully in their health, they’re no longer just managing symptoms—they’re taking control of their future.
Are you ready to bring more clarity and confidence to your work with clients?
If this is you: Join us in our group mentorship or 1-on-1 mentorship program, where we empower coaches like you to lead conversations about women’s health with knowledge and assurance. Together, we break down complex topics so you can go beyond the surface, recognize the nuances in client concerns, and truly make a difference.
Whether you're a seasoned coach or just starting, our mentorship is built to sharpen your skills and expand your knowledge, so you’re not simply providing answers—you’re offering meaningful support. Plus, our consultation services are here to equip you with personalized guidance and insight on challenging cases.
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