Posted under Women's Health by Dr. Sneha Tickoo



Suffering in silence- Heavy Menstrual Bleeding - Menorrhagia

Menstruation is a woman's monthly bleeding, often called your “period.” When you menstruate, your body discards the monthly buildup of the lining of your uterus (womb) which comes out through your vagina. From the start of the menstrual cycle, which is the first day of your period, your body starts to undergo a series of changes like the development of an egg from one of your ovaries and its subsequent release along with development of the lining of your womb. All these changes are happening to prepare your body for an anticipated pregnancy. In case there is no pregnancy, the womb sheds this lining which comes out in the form of blood as your period.


What is a “normal” period?

Every woman is different. It's difficult to define exactly what a normal period is because it varies from woman to woman. Normal for one woman may be abnormal for another. Mostly, periods last from anywhere between 2 days to 7 days. During this time, most women will lose less than 16 teaspoons of blood (80ml) during their period, with the average being around 6 to 8 teaspoons.


When a period is called “heavy”?

Heavy menstrual bleeding or menorrhagia is defined as losing 80 ml or more in each period, having periods that last longer than 7 days, or both. But it's not necessary to measure blood loss. Most women have a good idea of how much bleeding is normal for them during their period and can tell when this changes.


What are the some indications that your period is heavy?

If you have any of the following symptoms, you may have heavy menstrual bleeding:

  1.  You are having to change your sanitary products every hour or two
  2. You are passing large blood clots
  3. You are bleeding through to your clothes or bedding
  4. You need to use 2 types of sanitary product together


How common is Heavy Menstruation?

According to various studies, about 30% of women in the reproductive age group will suffer from heavy menstrual bleeding at some point. Unfortunately, it has been found that a lot of women will not approach a doctor even if there is good access to medical care available.


What are the causes of Heavy Menstrual Bleeding?

There are several conditions that can cause heavy periods. Certain age groups are more likely to have them, for example young girls who have just attained puberty. This is because their bodies are yet to fully mature. Also, women nearing menopause frequently complain of heavy periods that are irregular. Other likely causes of heavy periods are:

Endometrial polyps – non-cancerous growths in the lining of the womb or cervix (neck of the womb).

Fibroids- non-cancerous growths that develop in or around the womb and can cause heavy menstruation or painful periods.

Adenomyosis – when tissue from the womb lining becomes embedded in the wall of the womb; this can also cause painful periods.

Endometriosis - where the tissue that lines the womb (endometrium) is found outside the womb, such as in the ovaries and fallopian tubes (although this is more likely to cause painful periods). It can also lead to fertility issues.

Pelvic inflammatory disease - an infection in the upper genital tract (the womb, fallopian tubes or ovaries) that can cause symptoms like pelvic or abdominal pain, bleeding after sex or between periods, vaginal discharge and a high temperature.

Polycystic ovarian syndrome - a common condition that affects how the ovaries work; it causes irregular periods, and periods can be heavy when they start again.

Hypothyroidism – where the thyroid gland is underactive and does not produce enough hormones, causing lethargy, tiredness and weight gain.

Certain medical treatments like blood thinners or a copper IUD can also cause heavy menstrual bleeding.


What are the tests I will undergo if I have menorrhagia?

Your doctor will begin by asking you detailed questions about your period, including your flow, whether you have severe pain during your periods, what medications you are on, etc.

You will be asked to undergo a few blood test, first to see whether you are anemic and also to test for your thyroid status and other hormones, if required.

You will need to have an ultrasound scan which is a simple and effective way of finding the cause of your bleeding in a lot of cases.

Other tests may be prescribed based on your specific complaints.

How is heavy menstrual bleeding treated?

Treatment depends on what is the primary cause of your heavy bleeding. There are various treatment options which your doctor will prescribe based on what's causing your heavy periods, your general health and importantly, your preferences. Your desire to have children now, or in the future will also influence your treatment options.

For women who desire to conceive, your options can include:

  • Polypectomy- a procedure to remove endometrial polyps medicines without hormones – such as tranexamic acid or non-steroidal anti-inflammatory drugs (NSAIDS
  • Myomectomy – surgery to remove fibroids.

For women who do not wish to conceive immediately, you can be prescribed:

  • Medicines with hormones – such as the combined oral contraceptive pill or progestogen tablets. These will control your bleeding and also provide contraception.
  • Mirena intrauterine system (IUS) – a small device that contains the hormone progesterone is Inserted in your womb by a medical professional

For women who have completed their families and do not wish to conceive:

  • Endometrial ablation – a procedure to remove the lining of the womb
  • Uterine artery embolisation – a procedure to shrink fibroids
  • Hysterectomy, or the surgical removal of the womb should be the last option to control bleeding. It should be generally offered to women who are perimenopausal and have no relief with other treatments.

In conclusion, Menorrhagia or Heavy Menstrual Bleeding is a common problem faced by many women, mostly silently. It is a complaint that can have a significant impact on your quality of life. Always consult your gynecologist/doctor if you notice your periods are getting heavier over 3 months or longer.

    About the author

    The author, Dr. Sneha Tickoo is a Fertility Consultant at Care IVF Kolkata. For an appointment with the doctor, call +91-33-66-398-600. You can also book a Skype Consultation here.


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