Heavy Menstruation

Heavy menstruation or menorrhagia can result from multiple causes, some simple to treat and others more serious

Heavy menstrual flow or a heavy period is a common cause of consultation amongst women. Its clinical importance for women lies in its frequency of occurrence and the gravity of some of the causes.

I will consider below its medical definition, causes, indicators of a heavy period, diagnosis and its treatment.

What Are Heavy Periods?

The medical term for heavy menstruation is ‘menorrhagia’. Heavy menses is basically a problem of either the daily amount of menstrual flow, its duration or both. Normal menstruation usually last for about 3 to 7 days with a total blood loss of about 25 to 80ml.

When menses last longer than 7 days or become excessive each day, the overall amount of blood loss exceeds 80ml and this condition is called menorrhagia or heavy menses. It is also called hypermenorrhea though this term is often reserved for excessive bleeding within normal duration menstrual flow.

The typical characteristic of heavy menses is their regularity. Menorragia is predictable because it follows the regular menses. This is in contrast with metrorrhagia, which is intermenstrual bleeding.

How Do I Identify A Heavy period?

Yes, this question often comes up frequently when I use 25 to 80 ml to quantify bleeding in talking with women.”Who measures that?”

Heavy menstruation is not diagnosed by a lab measurement. It is estimated by you and your doctor! In fact the best doctor to diagnose the onset of heavy bleeding is you ,because you know what is normal for you. It is thus important you know normal menstruation and especially your individual variations.

You can estimate your flow by the number of pads or tampons you use, how frequently you change them and how soaked they are. It is estimated that a soaked pad can hold about 5 ml of blood.

Some pointers that should make you suspect heavy menstruation include

• Menstrual flow that soaks through one or more sanitary pads or tampons every hour
• The need to double your sanitary protection to avoid wetting your panties
• Night changes especially if you have not been doing so in the past
• Menstrual periods lasting longer than seven days
• Menstrual flow that includes large blood clots
• Heavy menstrual flow that interferes with your regular lifestyle
• Tiredness, fatigue or shortness of breath (symptoms of anemia)

Causes Of Heavy Menstrual Flow

There are many causes of heavy menstrual bleeding including

• Dysfunctional uterine bleeding. Hormonal imbalances without any identifiable disease. Common cause for perimenopausal woman and adolescence.
• Uterine Fibroids
• Uterine polyps. Small, non-cancerous growths on the lining of the uterus.
• Birth control methods. Pills and intrauterine devices.
• Pregnancy complications.
  A single, heavy, late period may be due to a miscarriage. If bleeding occurs at the usual time of menstruation, however, miscarriage is unlikely to be the cause. An ectopic pregnancy — implantation of a fertilized egg within the fallopian tube instead of the uterus — also may cause menorrhagia.
• Cancer. Rarely, uterine cancer, ovarian cancer and cervical cancer can cause excessive menstrual bleeding.
• Bleeding disorders. Inherited disorders such as Von Willebrand’s disease affect the ability of blood to clot and produce excessive bleeding.
• Medications. Examples include anticoagulants and aspirin.
• Chronic medical conditions. Examples are thyroid diseases, liver, or kidney diseases or genital diseases such as endometriosis, ovarian cysts or pelvic infections.

Diagnosis Of Heavy Menstrual Bleeding

Heavy menstruation requires medical evaluation. Be sure to seek medical care for its precise cause to be identified.

Common lab tests include

• Blood tests to check for anemia or causes such as thyroid problems.
• Pap test. This checks the cells of the cervi for inflammation or cancer.
• Endometrial biopsy. Your doctor takes a sample of tissue from the inside of your uterus to be examined under a microscope.
• Ultrasound scan. This imaging method uses sound waves to produce images of your uterus, ovaries and pelvis.

Treatment Of Menorrhagia

Treatment of heavy menstruation can either be with medications or by surgical procedures. Treatment if obviously determined mainly by the cause of the bleeding. Your doctor will discuss the options fitted for the specific case as well as the likely side effects of the treatment.

Medications

• HormonesThese constitute the major treatment for dysfunctional uterine bleeding. They may be given as pills, injections or even as an intrauterine device.
• Iron supplementsThis will often been prescribed to treat anemia and replenish the iron stores of the body. Taking foods rich in iron such as leafy vegetables and animal liver could be of added benefit.
• Other medications such as Nonsteroidal anti-inflammatory drugs (NSAIDs) could be used to control pain whenever needed.

Surgery

This may be

• Dilation and curettage (D and C) The cervix is dilated and the endometrium of the uterus is scrapped( curettage).
• Endometrial ablation. This procedure destroys the endometrium to stop the bleeding.
• Hysterectomy. This is removal of the uterus, often used as a last resort after all other methods have failled

What To Do At Home?

The first thing to do at home if you suspect heavy menses is to consult your doctor.

You could also have some rest, avoid aspirin and monitor your bleeding with the sanitary product you use.

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