Heavy Menstrual Bleeding
Heavy menstrual bleeding (menorrhagia) is a condition experienced by my women wherein they have abnormally heavy and prolonged menstrual bleeding. This condition prevents women from doing everyday activities. Along with excessive blood loss women also experience cramps and they may pass unusually larger blood clots. Blood loss is so severe that it causes anaemia.
Symptoms
Common symptoms of heavy menstrual bleeding include:
- Bleeding through a pad or tampon every hour for several hours
- Using double sanitary protection for heavy flow
- Passing large blood clots
- Period lasting more than 7 days
- Pain or cramps in the lower part of the stomach
- Need to change the pad or tampon frequently during the night
- Lack of energy
- Shortness of breath
- Heavy menstrual flow that makes daily activities difficult
Causes of Heavy Menstrual Bleeding
Major causes of excessive menstrual bleeding are uterine-related, hormone-related & other illness and disorders.
Uterine related causes:
- Tumours of the uterus which are also called as uterine fibroids. These fibroids are non-cancerous
- Use of intrauterine device (IUD) a non-hormonal birth control device
- Uterine or cervical cancer can cause excessive menstrual bleeding
- A condition called Adenomyosis in which the inner lining of the uterus breaks through the muscle wall of the uterus
- Pregnancy complications like miscarriage, ectopic pregnancy in which fertilized egg gets planted outside the uterus. These complications can also cause excessive menstrual bleeding
Hormone related causes:
- Blood related disorders like von Willebrand Disease (VWD) in which blood clotting factors are absent leads to excessive menstrual bleeding
- Non blood related disorders like liver, kidney or thyroid disease
Other illnesses and disorders:
- Conditions such as PCOS/PCOD, insulin resistance, thyroid, obesity cause hormonal imbalance due to which build-up of the lining of the uterus gets disturbed.
- Dysfunctional ovaries: when ovaries do not produce an egg during a menstrual cycle, ovulation gets disturbed and hormone progesterone is not produced due to which there is hormone imbalance
Excessive menstrual bleeding can lead to other complications such as anaemia caused by loss of RBCs and iron deficiency. Anaemia leads to pale skin, weakness and fatigue.
When to seek medical help
Get in touch with your doctor if you experience:
- Need of changing a pad or a tampon in less than 2 hours
- Passing large clots
- Excessive period cramps
- Bleeding after menopause
- Bleeding between your periods
- Period prevents you from doing normal daily activities
Heavy menstrual bleeding and infertility
In some cases of heavy menstrual bleeding, infertility may be caused due to:
- Surgery of removal of uterus (hysterectomy)
- Excessive bleeding caused by cancer
- Adenomyosis, a condition in which inner lining of the uterus breaks through the muscle wall of the uterus
- Hormonal imbalance issues leading to PCOS/PCOD
- Untreated anaemia
Diagnosis and Treatment
Excessive menstrual bleeding is diagnosed with the help of series of questions regarding menstrual history, family history, weight issues, stress problems, etc.
Physical exams or tests like pelvic exam, blood test to check thyroid, anaemia, ultrasound, Pap test, endometrial biopsy. Additional tests like sonohysterogram (to check the uterus lining); hysteroscopy (to detect any fibroids) may also be performed.
Treatment plan is tailored on the basis of intensity of the bleeding, medical history, overall health, age and future pregnancy plans.
Medicines that include iron supplements, pain killers, birth control pills, intrauterine contraception device (to regulate periods), and hormone therapy i.e. oral progesterone may be prescribed. Procedures like dilation and curettage (D&C) in which the doctor scrapes the outer lining of the uterus, may be done if any of the medicines do not work. Surgeries like removal of fibroids and hysterectomy (removal of uterus) may also be done in most extreme cases.
