10 Causes of Heavy menstrual bleeding: What to do

Heavy Menstrual Bleeding

Heavy menstrual bleeding is a very common complaint among a number of females of reproductive age. The bleeding can either be increased (heavy) or prolonged. This condition is known medically as menorrhagia.

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What is Heavy Menstrual Bleeding

HMB is when a woman suffers a blood loss of more than 80 ml in a single menstrual period. I know you would be wondering how you would measure the blood loss.
In simple terms, you can say a lady has Heavy menstrual blood if she uses more than 16 Soaked sanitary pads (on the average) or lasts more than 7 days or both in a single menstrual period.

Heavy Menstrual Bleeding
Image Credit: Theswaddle

However, there is no guaranteed way of saying how much menstrual flow is heavy. Most women have a way of knowing how much bleeding is normal for them and can tell when it changes.

It’s about your own idea that you think you are loosing much more blood that normal.

Cause of Heavy Menstrual Bleeding

HMB can be as a result of either hormonal or structural reasons. That is, it can be caused by an imbalance in the body hormones, or by a growth in the womb. A few of the common causes of HMB include;

  1. Fibroids: This is a common cause of increased menstrual bleeding beyond normal. Fibroids are benign growth in the uterus (womb) of a woman. They are Oestrogen sensitive. You can read more about fibroids here. One of the common symptoms are heavy bleeding during your menses.
  2. Adenomyosis: This is responsible for heavy menstrual bleeding in some women. Adenomyosis is a condition whereby endometrial tissues are found deep within the myometrium.

These are the 2 common causes of HMB. Other causes are;
3. Endometrial polyps: a form of growth in the Endometrium of the womb.
4. Coagulation disorders: a problem with the blood that affects its ability to clot. People with this problem can bleed out if nothing is done.
5. Pelvic inflammatory disease (PID): a complication of infections. If untreated can lead to infertility. Read more about this here.
6. Thyroid disease: due to possible over-activity of the gland.
7. Drug therapy (e.g. warfarin): affects the ability of blood to clot.
8. Intrauterine devices (IUDs): could have been inserted for contraceptive benefits.
9. Endometrial Cancer: This is cancer of the Endometrium of the Uterus (Womb).

10. cervical cancer: this is a malignant condition & should be taken seriously. Read more about this here.

What do I Do

Ladies experiencing Heavy menstrual bleeding are requested to visit the hospital & see a doctor (especially a gynaecologist). Your doctor would examine you to find out the cause of the increased bleeding & he/she would guide you on the available treatment options depending on the suspected cause.

Your doctor would carry out a pelvic examination (to check for masses) as well as cervical examination (to check for polyps or cancer). He/she might also take swabs to screen for infections.

Treatment

For some women, the amount of blood that is being lost is actually normal for them. Our concerns are with those who noticed an increases amount of loss more recently. For example, you do use 10-12 pads during a period before, and all of a sudden, you are now using up to 16-18 pads. That change is a cause for concern.

There are different treatments options that are available for the management of Heavy Menstrual Period. The choice and selection of treatment depends on the cause of the increased bleeding as well as of the woman still wants to have more children.

Medications available for HMB includes;

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen help reduce menstrual blood loss. They also have the additional benefit of relieving menstrual cramps.
  • LNG-IUS: a Form of Hormonal Contraception
  • Transexmic acid/mefenamic acid or combined oral contraceptive pill (COCP).
  • Progestogens.

Surgical option includes:

  • Endometrial ablation.
  • Myomectomy, Hysterectomy or umbilical artery embolization (UAE) for fibroids.

Your doctor would explain each of them to you, and also guide you on the best alternative for you.
Note, do not chose surgical options of you still have a desire to have more children.

Authors

  • Obasi Chinedu David attended the College of Medicine, University of Nigeria Teaching Hospital, in ituku-ozalla, Enugu state, Nigeria.

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