Heavy bleeding during periods

Dr Maxwell Adeyemi

Menorrhagia – heavy or prolonged menstrual bleeding – can be caused by a number of medical issues, including fibroids, uterine polyps, perimenopause, and other factors.

Chronic (prolonged) or heavy periods can lead to complications such as iron-deficiency anaemia. A typical period lasts four or five days. During that time, an individual sheds two to three tablespoons of blood. Those with menorrhagia can lose twice as much blood each month. Over time, repeated monthly loss of blood during menstruation often lead to anaemia or low blood count in women.

The following indicate menorrhagia, they are signs that you are losing too much blood during your period:

• Bleeding for seven or more days

• Needing to change a pad or tampon every hour for several hours

• Wearing more than one pad at a time in order to control the bleeding

• Having to change your tampon or pad in the middle of the night

• Passing menstrual blood that contains clots that are the size of a quarter or bigger

CAUSES OF MENORRHAGIA

There are a number of different causes of heavy menstrual bleeding:

Ovulatory dysfunction:

The most common cause of heavy menstrual bleeding is ovulatory dysfunction during adolescence or perimenopause. During this time, ovulation (releasing an egg) can be irregular, which means it might not happen every month. This can lead to thickening of the endometrium (uterine lining) and heavy periods.

Oral contraceptives can usually regulate your bleeding during adolescence, and hormone therapy can help during menopause.

Beyond the normal hormonal changes that occur with puberty or menopause, hormonally induced ovulatory dysfunction can also occur with hypothyroidism, polycystic ovary syndrome, and premature ovarian insufficiency and sometimes these may cause bleeding issues.

Uterine fibroids

Fibroids are growths that develop from the muscle of the uterus, usually between ages 30 to 49 but can occur earlier.

Uterine fibroids need oestrogen to grow. Hormonal birth control methods, like birth control pills, can help reduce heavy menstrual bleeding from fibroids.

If bleeding is not severe, a wait-and-see approach can be adopted because as menopause becomes established, fibroids typically shrink and disappear without treatment.

Progestin-releasing intrauterine devices can decrease menstrual bleeding but do not reduce fibroid size. Injectable gonadotropin-releasing hormone agonists can decrease the size but can only be used for a short time due to their side effects.

Endometrial ablation, in which the lining of the uterus is destroyed, is a procedure that can be used for the treatment of small fibroids.

Surgical options include myomectomy (removal of the fibroid) and uterine artery embolisation which cuts off the blood supply to the fibroid.

In the most severe cases, a hysterectomy may be warranted, in which the whole uterus is removed, with or without the ovaries.

Uterine Polyps

Endometrial polyps are typically non-cancerous, grape-like growths that protrude from the lining of the uterus. They can develop before and after menopause. The cause of endometrial polyps is unclear, though research suggests a link between hormone therapy and obesity.

The treatment of small polyps is unnecessary unless the patient is at risk of uterine cancer. Polypectomy, which is the removal of polyp for microscopic examination, is usually done. Large polyps are routinely removed and examined as a precaution to rule out the possibility of cancers.

Uterine adenomyosis

Uterine adenomyosis is a condition in which the endometrial uterine cells grow into the muscular wall of the uterus, causing uterine enlargement and painful, heavy bleeding.

Hormonal birth control methods can help control the condition, but the definitive treatment for adenomyosis is a hysterectomy.

Pelvic inflammatory disease

Pelvic inflammatory disease is most often caused by an untreated sexually transmitted infection; however, it can sometimes occur following childbirth, abortion, or other gynaecological procedures. In this condition, one or more reproductive organs can be infected including the uterus, fallopian tubes, and cervix. Treatment of this condition is usually by antibiotics.

Cervical or endometrial cancer

Cervical cancer, which can be caused by human papillomavirus, an asymptomatic sexually transmitted disease, can invade other parts of the body.

Endometrial cancer occurs when abnormal cells in the endometrium grow into the uterus and/or other organs. While the cause of endometrial cancer is unknown, the most common age for diagnosis is the mid 60s.

Early diagnosis is vital to effective treatment of cancer, in addition to regular Pap smear screening, women at risk of endometrial cancers should have an annual endometrial biopsy.

Bleeding disorders

While there are several types of bleeding disorders, the most common type in women is von Willebrand disease (VWD). Treatments for von Willebrand disease involve releasing stored clotting factors in the blood or, in extreme cases, replacing the clotting factor via an intravenous route.

Other bleeding issues that can lead to heavy menstrual bleeding include having a low platelet count (platelets are involved in the clotting process and are produced in the bone marrow) or taking a blood thinner like aspirin or warfarin.

DIAGNOSIS

It's important that you get a diagnosis for the cause of your heavy menstrual bleeding.

The nature, pattern and quantity of bleeding should be ascertained.

The list of all your medications should also be noted, including hormonal birth control, hormone therapy, blood thinners and any vitamins or over-the-counter supplements.

It will also be necessary to do diagnostic tests, such as:

• A pregnancy test – if you are premenopausal.

• Blood tests; for example, a complete blood count, iron levels, and thyroid hormones.

• An ultrasound of your pelvis.

Your healthcare provider or gynaecologist may also do a hysteroscopy, a diagnostic procedure used to visualise the inside of your uterus.

It may also be necessary to do an endometrial biopsy to sample your uterine tissue for microscopic examination.

Getting to the bottom of the heavy menstrual bleeding is important for the patient’s quality of life and for their overall health. Heavy blood loss, regardless of the cause, can cause iron-deficiency anaemia, which can make the patient short of breath, tired, and dizzy.

Once both the bleeding and the root cause of the bleeding are addressed and treated, the patients should live a normal and healthy life.

Consult your family doctor or a gynaecologist if you are experiencing heavy or abnormal menstrual bleeding.

Contact Dr Maxwell on 363-1807 or 757-5411.