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Guide to Menstruation
|Heavy Periods (Menorrhagia): Defined
A heavy period, also known as menorrhagia (and hypermenorrhea), is defined as excessively heavy or prolonged bleeding during a period. This could be soaking a pad or tampon every hour for more than 3 hours, or bleeding for longer than 7 days. Menstrual flow may include large clots of blood and result in extreme tiredness or shortness of breath - signs of anemia. Menorrhagia is where more than 5 1/2 tablespoons (81 ml) of blood is lost during the menstrual cycle. As a general guide, a tampon usually soaks about 5ml of blood. For some women, heavy bleeding can simply be inconvenient, at worst it may cause anemia because of blood loss. For other women menorrhagia may make it difficult for them to go about their everyday life.
What Causes Them?
Occasional heavy periods are quite normal. They may occur after pregnancy, or delivery and childbirth (and miscarriage) but usually resolve within 2 or 3 months. Some women are more prone to heavy bleeding when they are tired or stressed. To avoid this, make a note when a period is due, and try to get some extra sleep and take iron supplements 3 or 4 days before you are due. Causes of regular heavy bleeding include:
1. A hormone imbalance is the most common cause of menorrhagia in both teenagers after menarche (first period) and women approaching menopause, in the perimenopause phase. Menstrual periods at both these times in life tend to be irregular and do not always result in ovulation. See also, what can cause a change in my monthly cycle?
2. In other cases, where it occurs in an adult woman in her 20s and 30s, a problem in the blood vessels of the uterus can result in a failure to control bleeding.
3. Uterine fibroids are another common cause as well as hypothyroidism, endometriosis, uterine polyps, cervical polyps and adenomyosis.
4. A heavy bleed with blood clots in early pregnancy could indicate pregnancy complications such as miscarriage or ectopic pregnancy. See: What are the signs of a miscarriage?
5. Some contraceptive intrauterine devices (IUDs) can cause heavy periods.
6. In rare cases menorrhagia may indicate a bleeding disorder such as Willebrand disease.
7. Certain medications, including anti-inflammatory medications and anticoagulants (to prevent blood clots) can cause menorrhagia.
8. Thyroid disease can also cause heavy bleeding, particularly if it is left untreated.
9. Heavy periods with unusual vaginal discharge may be symptoms of pelvic inflammatory disease. This condition needs instant treatment.
Who Is Prone To Menorrhagia?
As a hormone imbalance is the most common cause of menorrhagia, the following two groups of women are most at risk of developing the disorder:
Teenagers who have recently starting menstruating. Girls are most at risk for the first year and a half after menarche.
Women approaching menopause. Hormone fluctuations can cause changes to menstrual cycle patterns, also resulting in missed and painful periods.
A doctor can usually diagnose menorrhagia with a pelvic exam, combined with a Pap smear test to check for inflammation. Where an underlying condition is suspected:
Tests: Blood tests may be carried out to check for anemia, thyroid disorders or blood-clotting problems.
Scans: An ultrasound scan may be carried out if fibroids are suspected.
Biopsy: An endometrial biopsy may be carried out to take a sample of tissue from the inside of the uterus for examination (see also endometriosis diagnosis).
If an underlying condition is responsible for heavy periods, the condition needs to be rectified first to see any alleviation of symptoms. If menorrhagia is not caused by an underlying disorder:
1. It may be treated with a combined contraceptive pill (which contains both estrogen and progesterone). This is also recommended to women with irregular periods and those who frequently have missed periods.
2. An IUD device (Mirena) may be suggested as an alternative to women who have already had children. The Mirena IUD releases a type of progestin called levonorgestrel. This thins the lining of the uterus to decrease menstrual blood flow and cramping.
3. Nonsteroidal anti-inflammatory painkillers (NSAIDs) such as ibuprofen (brand names Advil, Nuprin, Motrin) can help reduce bleeding and menstrual cramps. AVOID aspirin as it interferes with blood clotting.
4. Women who suffer repeat bouts of heavy bleeding may need to take an iron supplement to prevent anemia.
5. Sometimes heavy bleeds are associated with worse premenstrual syndrome (PMS), or it's more severe version premenstrual dysphoric disorder (PMDD) which is often treated with prescription medications like antidepressants.
6. If menorrhagia persists despite medications, a D&C procedure (Dilation and curettage) may be carried out, scraping the lining of the uterus to reduce bleeding. This procedure is usually effective, but may need to be repeated if menorrhagia returns. It is usually done on an outpatient basis.
7. Surgery: Where bleeding continues to seriously affect a woman's quality of life, endometrial ablation may be carried out. This is performed in women who wish to avoid a hysterectomy. The procedure destroys the lining of the uterus and is almost 90 percent effective at reducing excessive bleeding. A woman however is usually left infertile. This procedure is usually done on an outpatient basis.
8. Women who do not wish to have any more children may opt for a hysterectomy.
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