Excessive Bleeding, Or Menorrhagia Needs Medical Attention
- Hormone imbalances, certain medications, uterine polyps, and bleeding disorders can cause a woman to have heavy menstrual bleeding (HMB).
- HMB aka Menorrhagia is defined as any period that lasts longer than 7 days.
- Understanding the causes and symptoms behind Menorrhagia.
- Understanding the causes and symptoms of Abnormal Uterine Bleeding.
- If your periods last for more than one week and you experience symptoms like fatigue, breathlessness, needing to change your tampon/pad every hour, pelvic pain and so on, it is best to get a medical diagnosis.
- Menorrhagia and other AUBs can be diagnosed with simple tests like blood tests (to check for anemia and rate of blood clotting), and PAP smear tests (to check for infections and cancerous cells).
- Understanding how menorrhagia and abnormal uterine bleeding can be treated.
Across the world, excessive bleeding during periods is one of the most common health problems faced by women. The medical term for heavy menstrual bleeding is menorrhagia, and the condition usually leads to periods that last longer than 7 days or result in unusually high levels of blood loss during long and heavy periods.
The definition of ‘heavy menstrual bleeding is not one-size-fits-all; it varies from woman to woman, depending on several factors. But if periods interfere with a woman’s daily life, causing severe fatigue, among other symptoms, there is no reason to accept the condition, because it can be and should be medically managed.
- According to a medical survey, 18.2% of women in China, in the age group of 18-50 years, suffer from heavy menstrual bleeding because of uterine fibroids and multiple abortions.
- 1 out of 10 women suffering from heavy menstrual bleeding may have bleeding disorders like von Willebrand disease.
How long does a regular menstrual cycle last?
On average, a woman starts menstruating at the age of 12-13 years and goes on till her mid-50s, after which she becomes menopausal (i.e., she has no more menstruation). An average menstrual cycle is 28 days long, but it can range anywhere between 21 and 35 days, depending on a woman’s physical, emotional, and hormonal makeup.
A menstrual period is when a woman bleeds; usually, a period lasts from 2 to 7 days. However, hormone imbalances, certain medications, uterine polyps, and bleeding disorders can cause a woman to have heavy menstrual bleeding. This condition, menorrhagia, can cause a woman’s periods to go on for more than 7 days. It also leads to more than the normal menstrual blood loss of 70-80 ml in one cycle.
Menstruation itself is a perfectly normal physical function for women. Every month, a woman’s uterus prepares for pregnancy. The uterus lining grows thicker, a single egg is released from the ovary, and it waits in the uterus to be fertilized by male sperm, so that a human embryo — the first stage of a baby — may be created.
When the expected pregnancy does not occur, the body readjusts the hormone levels and sheds the lining of the uterus. The lining passes through the vagina, along with some bleeding, before the next menstrual cycle may begin.
Excessively heavy menstrual bleeding, therefore, could be signaling to a woman that all is not right with her body.
1. Menorrhagia: Symptoms and causes
Heavy menstrual bleeding may need medical attention because there are other forms of dysfunctional uterine bleeding — more commonly known as abnormal uterine bleeding (AUB) — that can also lead to excessive bleeding and longer than usual periods. These include polymenorrhea, metrorrhagia, and dysmenorrhea.
- Menstrual periods that last longer than 7 days
- Need for using double sanitary pads at the same time
- Tampon or pad getting completely soaked within an hour, and then soaked again soon after changing the tampon or pad
- Need to change tampon/pad in the night
- Period blood also passing blood clots that look larger than normal
- Fatigue and shortness of breath while menstruating
2. Causes of excessive bleeding during menstruation
- Hormonal imbalance caused by thyroid, obesity, insulin resistance, polycystic ovarian syndrome (PCOS), or dysfunctional ovaries. These can lead to an imbalance between estrogen and progesterone, which in turn leads to excessive bleeding.
- Uterine fibroids and uterine polyps (benign growths that crop up on the uterine lining) can lead to prolonged menses, as can medical conditions such as adenomyosis, cancer, bleeding disorders like von Willebrand disease, or platelet function disorders.
- Use of a non-hormonal Intrauterine Device (IUD), a form of birth control whose common side-effect is excessive menstrual bleeding.
3. Abnormal uterine bleeding: Symptoms and causes
Apart from menorrhagia, there are other forms of excessive bleeding that are reflected as menstrual spotting, prolonged menses, and excessively heavy menstrual flow.
- Polymenorrhea (getting periods too frequently)
- Metrorrhagia (bleeding between periods)
- Dysmenorrhea (having periods with extreme pelvic pain)
While menorrhagia and abnormal uterine bleeding (AUB) are both characterized by heavy, long, or painful periods for most parts, an important difference between the two is:
- Menorrhagia occurs during an expected time (during regular periods)
- AUB can occur in unexpected phases, including between two menstrual cycles, post-intercourse, and post-menopause
- Polycystic ovarian syndrome (PCOS), obesity, thyroid disease, anovulation, and other problems caused by hormonal imbalance can lead to AUB, as do structural uterine changes such as polyps and fibroids.
- Pre-cancer or various types of gynecological cancers, such as uterine, vaginal, ovarian, endometrial, or cervical cancer. Women who have AUB must get themselves tested for cancer.
- Sexually transmitted infections such as gonorrhea and chlamydia can also lead to AUB.
- Bleeding disorders such as von Willebrand disease and platelet disorders, along with certain medications such as blood thinners, certain birth control pills, IUDs, and some drugs used to treat breast cancer.
- Psychological stress or depression for a prolonged period.
- Extreme hormonal imbalances after menopause.
How Menorrhagia and AUB: Risks, tests, treatment
While not every heavy period will convert into menorrhagia or AUB, persistently heavy menstrual bleeding can lead to severe anemia, which in turn leads to arrhythmia, enlarged heart, or heart failure.
The underlying cause(s) of menorrhagia and AUBs are diagnosed with simple tests like blood tests (to check for anemia and rate of blood clotting), and PAP smear tests (to check for infections and cancerous cells).
Depending on the degree of seriousness of the problem, doctors may resort to other methods like ultrasound scans (to check for fibroids), biopsy (to see if the uterus lining contains cancerous cells), and hysteroscopy.
Doctors may suggest tranexamic acid pills (usually available over the counter on prescription) to reduce the blood flow, along with, anti-inflammatory painkillers to reduce the pain.
For a persistent problem of heavy menstrual bleeding, doctors look deeper for causes of menorrhagia or AUVs. Treatment procedures vary according to the causes.
- If the bleeding is due to hormonal imbalances, the doctors may suggest prostaglandin inhibitors, progesterone treatments, or birth-control pills regulate the hormonal balance.
- If blood tests and PAP smears discover the problem to be in the uterine structure, surgical procedures like ablation (destroying the uterine lining), resection (removing the uterine lining), and hysterectomy (removing the uterus) may be advised.
Home remedies for heavy menstrual bleeding
Aside from taking medical advice for treating heavy menstrual bleeding, women should also take care to compensate for the excessive loss of iron and fluid through the menstrual flow.
- Drinking extra water or a bit of electrolyte solution
- Drinking a glass of water a day mixed with salt and sugar
- Eating iron-rich foods like spinach, chicken, and beans, to prevent anemia
- Cooking in iron vessels for the same reason
- Eating foods rich in Vitamin C, e.g. lemon, sweet lime, oranges, and tomato, to help the body absorb iron better
Excessive bleeding (heavy menstrual bleeding) or menorrhagia is a common medical concern for millions of women around the world. If the heavy bleeding occurs outside the normal menstrual cycle or after menopause, then it is termed abnormal uterine bleeding. In both cases, medical intervention is necessary, as there may be serious underlying causes, including cancer. Also, the excessive bleeding may lead to even a heart failure.
Once long heavy period causes have been identified, treatment for the condition can help a woman lead a normal life with minimal discomfort. At the same time, diet and healthy food too can play a crucial factor in matters related to menstrual health.
- Kansas City Ob-Gyn - https://www.kcobgyn.com/blog/four-abnormal-menstrual-periods
- EHC - https://www.ehc.eu/bleeding-disorders/women-with-bleeding-disorders/
- BMC Women’s Health - https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-019-0726-1
- The Society of Obstetricians and Gynaecologists of Canada - https://www.yourperiod.ca/abnormal-pain-and-menstrual-bleeding/heavy-menstrual-bleeding/
- Mayo Clinic - https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829#:~:text=Menorrhagia%20is%20the%20medical%20term,to%20be%20defined%20as%20menorrhagia.
- NHS - https://www.nhs.uk/conditions/heavy-periods/
- Cleveland Clinic - https://my.clevelandclinic.org/health/diseases/15428-uterine-bleeding-abnormal-uterine-bleeding
- John Hopkins Medicine - https://www.hopkinsmedicine.org/health/conditions-and-diseases/menorrhagia