Heavy Periods
Menorrhagia is a condition of abnormally heavy or prolonged menstrual bleeding. Uncontrolled/untreated menorrhagia may cause blood loss and pain that impacts on your usual activities.
Symptoms
The Most Common Symptoms of Menorrhagia are:
- Severe menstrual flow that necessitates use of multiple pads every hour for several consecutive hours
- The need to use double sanitary protection to control the flow of blood
- Disturbed sleep or frequent awakening in night to change your pad
- Prolonged bleeding period for more than 7 days
- Large blood clots in the menstrual flow
- Fatigue, weakness or shortness of breath
Causes
- Dysfunctional uterine bleeding.
- Although ‘dysfunctional uterine bleeding’ sounds like a specific diagnosis, it is a term that is often used when the periods are heavy and no other cause can be found.
- It does not seem to be associated with hormonal effects or other conditions.
- Sometimes it is more common in the lead-up to menopause.
- Uterine fibroids (noncancerous tumours of the uterus)
- Uterine/endometrial polyps.
- Adenomyosis (endometriosis in the muscle wall of the uterus).
- Hormonal Disorders.
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- Sometimes, disturbances of hormonal secretion in the body can cause an abnormal build-up of the lining of the uterus (endometrium).
- This lining then breaks down and the abnormally thick tissue is passed, leading to a heavy menstrual loss.
- One common example of this is polycystic ovarian syndrome (PCOS) which can cause irregular and heavy periods.
- Sometimes diseases of the thyroid gland can lead to heavy menstrual bleeding.
- Rare causes. In rare cases, conditions such as endometrial hyperplasia (abnormal overgrowth of the lining of the uterus), cancer of the uterus, bleeding disorders, or the use of medications can cause heavy bleeding.
Investigations
May include the following:
- A pelvic examination (an internal vaginal examination).
- Pelvic ultrasound scan.
- A biopsy of the lining of the uterus. Biopsy is a technique for removing a piece of tissue from the inner lining of the uterus and is examined under a microscope. This is done to check for any abnormalities.
- Hysteroscopy – a procedure that involves placing a tiny tube with a light source through your cervix to obtain a direct view of the lining of the uterus.
Treatment options
Treatment options will depend on the cause of menorrhagia, the severity of menorrhagia and the overall health status of the patient.
Some common treatments
- Iron supplements may be started if you also have anaemia
- Nonsteroidal anti inflammatory drugs (NSAIDs) may help reduce menstrual blood flow as well as cramping
- Oral contraceptives may be given to help reduce bleeding and your menustrual cycle more regular
- Hormonal preparations such as oral progesterone may be given to correct hormonal imbalance and reduce menorrhagia
- Tranexamic acid – a medication which works by making clots that line the uterus and limit bleeding. Tranexamic acid is taken three or four times a day during the period, and can reduce bleeding a great deal.
- Surgery may be needed if medication therapy is not successful.
Treatment Types
Surgical procedures such as hysterectomy and endometrial ablation should only be performed on women who have completed their childbearing. Therefore discuss with your doctor about your treatment options especially if you plan to become pregnant in the future.
