Heavy Menstrual Bleeding

Heavy menstrual bleeding (HMB) or menorrhagia is one of the most common reasons for which women seek a Gynaecologist’s help.  There are over 355 million menstruating women in India and about 60% of them may need medical help at some time in their lives to deal with heavy periods. It is not always a cause for alarm, but in some cases, it can lead to diagnosis of underlying causes which need treatment.

Why do Women have Periods?

Imagine a life without periods – no bleeding, no pain, no sanitary napkins and no tampons ……. freedom.  Before you get too carried away with that utopian thought, have you ever wondered why women have periods?  Well, it’s because we are special of course!  Every month the womb prepares for a possible pregnancy and when this does not happen it sheds the lining of the womb which results in a period or menses.  This usually happens once a month and a woman bleeds on an average for 5 days.  The normal cycle varies from 21 to 35 days and the bleeding can last from 2 to 7 days. So, having a regular period most often indicates that a woman is ovulating every month.  So, ladies the next time you moan about your periods remember it is your monthly reminder that you are capable of having a baby!

How do you make out if the bleeding is bad enough to seek attention?

• Do you have to change tampons or pads every hour for several consecutive hours? If you are using a menstrual cup, does the menstrual bleeding exceed 80 ml each menstruation?
• Do you have to change pads/tampons in the night?
• Do you pass large blood clots throughout your menstruation?
• Do you have to restrict physical activities during your menstruation due to heavy bleeding?
• Do you bleed longer than a week?
• Do you have symptoms of anaemia, such as tiredness or shortness of breath?
• In short, is your period disrupting your normal life every month?

Then it is high time you sought help to get back to a normal life.

We should find out what causes HMD before we can address it

Any hormone problem or condition that affects the uterus can cause heavy bleeding.

Hormone imbalances can occur due to thyroid dysfunction, polycystic ovarian syndrome (PCOS), dysfunction of the ovaries, obesity and insulin resistance.

Non-cancerous tumours of the uterus like polyps or fibroids may cause prolonged and heavy menstruation.

Sometimes the lining of the uterus can grow into the muscular wall of the uterus. The lining or the endometrium then continues to thicken, breakdown and bleed like normal during each menstrual cycle leading to heavy painful menstruation.

HMB is a known side effect of a non-hormonal intrauterine device for birth control.

In the first trimester, signs of a miscarriage can mimic a menstrual period, because there will be bleeding and clotting

Some bleeding disorders can cause abnormal menstrual bleeding.

Certain medications, Such as anticoagulants can contribute to heavy or prolonged menstrual bleeding.

Although it should not be the first thought at the sight of a heavy period, cancer does form a small possibility, especially in cases of older women.

Can it happen at any age?

Heavy bleeding during menstruation can happen at any age, but the reasons behind it may vary.

Adolescent girls are especially prone to HMD in the first year after their first menstrual period.

What can I expect when I see the doctor?

Your doctor will ask you about your medical history and about your periods. You will also have a physical exam including a pelvic exam. You may be asked to keep track of your periods and how many pads or tampons you use for a few months if you haven’t already done so.

Some of these tests may be prescribed depending on the details of your personal condition.

• Blood tests: These check for anaemia, test for how fast your blood clots and other conditions such as thyroid dysfunctions.
• Pap smear: For this test, cells are collected from the cervix and examined. It’s used to check for pre-cancerous changes.
• Ultrasound: You can be checked for fibroids or other problems inside the uterus and outside such as ovaries.
• Biopsy: Examining a tissue sample from the uterine lining can help your doctor find cancer or other abnormal tissue.
• Based on these results, sometimes your doctor may ask for further tests like
• Hysteroscopy: Using a viewing instrument inserted through the vagina, your will be able to see the inside of the uterus.

How is it treated?

Your doctor will consider your age and overall health when finding the best treatment for you.

Treatment for hormone problems may include:

• Tranexamic acid: Tranexamic acid helps reduce menstrual blood loss and only needs to be taken at the time of the bleeding.
• Non-steroidal anti-inflammatory drugs (NSAIDS): They help reduce cramping and the amount you bleed.
• Birth control pills These stop ovulation and result in lighter periods.
• Oral Progesterone: This is a type of hormone treatment that can help restore the hormonal balance and reduce the bleeding.
• LNG-IUS (Levonorgestrel Intrauterine System) This is a hormone containing device that is inserted into the uterus (Similar to a copper IUD) to reduce bleeding.
• Iron supplements: If you have anaemia as a result of the heavy loss of blood, you may be prescribed iron supplements.
• Surgical Option In case you do not respond to medical treatments, your doctor may explore surgical options.

Bottom line:

In general, it’s likely you know when something seems wrong down there—get it checked just to be safe.

The symptoms of menorrhagia may look like other conditions or medical problems. Always consult your doctor for a proper diagnosis.