Heavy menstrual bleeding which is medically referred to as MENORRHAGIA is used to describe a menstrual bleed that is increased in duration or quantity.
i.e. if it continues for more than 7 days, or less than that, but associated with passage of large clots or need to change pads or tampons that are completely soaked at least once in every 1 or 2 hours or overflow even after the usage of extra-large size sanitary pads.
When you realize you are going through this problem it is advisable to consult a gynecologist to investigate the probable cause and get treated because long standing neglected heavy periods can lead to…..
ANAEMIA and its complications namely
- extreme fatigue
- breathlessness and
- preventing one from doing day to day work.
So what are the probable causes that leads to menorrhagia….
1) HORMONAL IMBALANCE….the most common cause when there is an imbalance in the normal cycle of female hormones namely estrogen and progesterone. In such situations the menstrual cycle is delayed and followed by heavy or prolonged bleeding.
This pattern is common during the first one year following menarche (attaining periods for the first time). This is because of the immaturity of the hormonal axis.
This also happens with people who have polycystic ovaries or increased levels of the hormone Prolactin(milk secreting hormone) or deficiency of thyroid hormone or are just overweight!
2) Endometrial polyps: a non cancerous excessive growth of the lining of uterus
3) Fibroid s: non cancerous growths from the wall of the uterus
4) Adenomyosis: the tissue that lines the uterus is seen in the muscle layer of the uterus.
5) Intrauterine contraceptive device
6) Medical bleeding disorders (rarely)
7) Unhealthy pregnancy that is miscarrying, especially when one is not aware of being pregnant, can also present as menorrhagia.
8) Cancer of the lining of uterus or the cervix can present as heavy vaginal bleeding especially if the woman is postmenopausal.
9) Rarely blood thinners given for various medical conditions.
Diagnosis and investigations
- Includes your gynecologist speaking to you to understand the problem,
- examining you and taking a pap smear
- A basic pelvic scan
- A hormonal work up including thyroid profile
- complete blood count.
Depends on the cause of heavy bleeding.
Iron supplements are given if your hemoglobin is less than normal.
If cases of hormonal imbalance, management starts with weight loss if obese, then non hormonal treatment are tried with Tranexmic acid
If it fails, hormones in the form of oral tablets or injectables or as an intrauterine device (called Mirena) is used.
Endometrial polyp is surgically removed by hysteroscopic polypectomy.
Adenomyosis is treated majorly with hormones.
Fibroids in the uterus can be treated with hormone modulating medications or surgical removal of the offending fibroid or the uterus itself.