Choose the content to read

• Heavy Menstrual Bleeding
• What are the symptoms of OAB?
• When to see a doctor?
• What causes heavy menstrual bleeding?
• How is heavy menstrual bleeding diagnosed?
• How is heavy menstrual bleeding treated?
• How to prevent heavy menstrual bleeding?

Heavy Menstrual Bleeding

Heavy menstrual bleeding (formerly known as Menorrhagia) occurs when your menstrual blood loss is more than 80 milliliters (5-6 tablespoons) in a cycle or your period lasts longer than seven days. In regular menstruation, an individual typically loses 35 to 40 milliliters (2-3 tablespoons) of blood over four to eight days. Heavy menstrual bleeding can lead to anemia, weakness, and fatigue.

What are the symptoms of heavy menstrual bleeding?

• Pain in the lower abdomen.
• Having menstruation longer than seven days.
• Menstrual blood loss of more than 80 milliliters. (Typical is 35-40 milliliters.)
• Passing blood clots larger than a quarter.
• Experiencing anemic symptoms such as shortness of breath and fatigue.
• Have to change a tampon or sanitary pad every hour for at least two consecutive hours.

When to see a doctor?

If you have heavy bleeding that you need to change your tampon or pad every hour, experience vaginal bleeding between periods or unusual vaginal bleeding, or have bleeding after menopause, consult with a gynecologist for proper diagnosis and treatment.

What causes heavy menstrual bleeding?

• Hormone imbalances: Hormones such as estrogen and progesterone regulate the menstrual cycle. However, being overweight or having health conditions like anovulation, thyroid disease, and polycystic ovary syndrome (PCOS) can cause hormone imbalances, leading to heavy menstrual bleeding.
• Benign growths in your uterus:Uterine polyps,fibroids, and adenomyosis can cause abnormal growth of cells in the uterus, contributing to excessive menstrual bleeding.
• Cancerous growths in the uterus:Endometrial hyperplasia, uterine cancer, orcervical cancer can cause heavy menstrual bleeding.
• Sexually Transmitted Infections:These include chlamydia, gonorrhea, trichomoniasis, and chronic endometritis.
• Pregnancy complications:Heavy bleeding during pregnancy can be a sign of miscarriage, ectopic pregnancy, or a hematoma in a C-section wound.
• Other medical conditions: Heavy menstrual bleeding can be due to hereditary bleeding disorders like Von Willebrand disease and other diseases, such as liver disease, kidney disease, pelvic inflammatory disease, leukemia, or platelet disorders.
• Medications:Anticoagulants, aspirin, hormone replacement therapy, breast cancer drugs like Tamoxifen, birth control pills and injectables, and intrauterine devices can potentially lead to abnormal uterine bleeding.

How is heavy menstrual bleeding diagnosed?

• History and physical exam. Your doctor will inquire about your symptoms and conduct a physical and pelvic exam.
• Blood tests to check your iron levels and determine if you have anemia, thyroid disease, or a bleeding disorder
• A Pap test can diagnose if you have an infection, inflammation, or indication of cancer.
• A transvaginal ultrasound to evaluate organs and tissues in your pelvic region
• A sonohysterogram or saline-infusion sonography can assess the lining of the uterus by filling it with saline. This method can detect any intrauterine lesions more accurately than a regular ultrasound.
• An endometrial biopsy can identify cancer or abnormalities of the endometrium.
• Magnetic resonance imaging (MRI) can display abnormal structures inside the uterus.
• A hysteroscopy can inspect the vagina, cervix, and uterus for polyps, fibroids, or other abnormalities which are removable in the same sitting.
• A cervical culture can identify an infection in the uterus.

How is heavy menstrual bleeding treated?

Suitable treatment modalities depend on the cause and severity of heavy menstrual bleeding, age and medical history, body response to medications, and preferences. Your gynecologist can recommend options appropriate for your symptoms and pregnancy plan.

Medications

• Nonsteroidal Anti-inflammatory Drugs (NSAIDs) like ibuprofen or aspirin can alleviate cramps and diminish bleeding.
• Oral contraceptives, vaginal rings, patches, or IUDs may promote regular periods and reduce blood flow.
• Hormone replacement therapy can balance estrogen and progesterone levels, potentially reducing heavy menstrual flow. It is also suitable for perimenopausal-related heavy bleeding.
• Antifibrinolytic medications, such as tranexamic acid, can swiftly slow menstrual bleeding by aiding the blood clotting system.
• Gonadotropin-releasing hormone (GnRH) agonists can temporarily halt or lessen bleeding by inhibiting ovulation.

Surgical procedures

• Hysteroscopy
• Myomectomy
• Uterine artery embolization can limit blood flow to fibroids and tumors.
• Endometrial ablation can eliminate all or part of the uterine lining. Often, doctors would recommend sterilization afterward to avoid serious complications should pregnancy occur, as endometrial ablation poses risks to a future fetus.
• Hysterectomy

Which treatment is right for me?

In general, doctors recommend medications.

If you plan for a pregnancy in the next few months, nonsteroidal anti-inflammatory drugs (NSAIDs) or antifibrinolytic medicines would be suitable. However, NSAIDs may not be as effective in addressing heavy menstrual bleeding compared to hormonal treatments.

If pregnancy consideration is far off in the future, hormonal birth control methods, a hormonal IUD, progestin pills, or injectable progestin may be viable options.

If you decide against any future pregnancies, any of the above-mentioned medical treatments can be used. Among them, hormonal birth control (including the IUD) and antifibrinolytic medicines are likely the most effective.

If one or more medications are not effective, doctors may suggest surgical treatments.

How to prevent heavy menstrual bleeding?

Preventing heavy menstrual bleeding may not always be possible. If you experience symptoms, it is advisable to seek guidance from your gynecologist for an accurate diagnosis and effective treatment to address your condition.

Preparation to see a doctor

• List your symptoms, medications you are taking, and personal information.
• Write down questions you would like to ask your doctor. For example:
• What are the causes of my symptoms?
• Do I need to undergo any diagnostic procedure?
• Are my symptoms temporary?
• What treatment options are available?
• How can I manage my preexisting condition?

Prepare answers to questions your doctor may ask. For example:

• When did you first experience the symptoms?
• Are your symptoms intermittent or continuous?
• Are your symptoms progressive?
• What improves or worsens your symptoms?

FAQ

• Is heavy menstrual bleeding life-threatening?
  Usually, it is not. However, excessive blood loss can pose a risk. Seek immediate medical care if you change your sanitary pads or tampons every hour for two hours.
• What is considered normal menstrual bleeding?
  While having menstruation, changing a tampon or sanitary pad every 3-4 hours is considered normal. If you need to change them more frequently or wear two pads at the same time, you may have heavy menstrual bleeding.

A note from MedPark’s doctors

Heavy menstrual bleeding can bring discomfort. If the condition interferes with your daily life, consult your gynecologist for medical care to alleviate your symptoms and provide relief.