Those one week every month is excruciatingly painful and an annoyance for every woman. A consistent struggle with work and menstrual pain crosses boundaries of patience and tolerance. We generally admire those one week to be stress-free and peaceful existence but then, things aren’t always as we want them to be.
The monthly menstrual period varies from one woman to the next. Some women typically have light periods, while others are accustomed to heavier bleeding. Other factors that affect your menstrual cycle include your age- for instance, menopause can bring changes, including periods that are longer, shorter, heavier, or lighter. Likewise, menstrual cycles can vary at puberty and during adolescence.
However, in some cases, if a period lasts more than seven days and the bleeding is excessive or heavy, it could be a sign of a condition called menorrhagia, or heavy menstrual bleeding.
What is Menorrhagia
Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding. Menorrhagia is a common disorder in women, with about 1 in every 20 women suffering from the condition. Although many report heavy menstrual bleeding during their periods, women with menorrhagia might need to change their tampon or pad every two hours or more and experience severe cramps.
Average blood loss during menstruation is around 30 to 40 milliliters, or 2 to 3 tablespoons, over a period of 4 to 5 days. Menorrhagia, on the other hand, is a loss of over 80 milliliters of blood in one cycle, or twice the normal amount. Women diagnosed with the menstrual condition may also pass blood clots larger in size than a quarter. Menorrhagia not only disrupts your normal everyday activities and tasks, but the excessive bleeding also can lead to anemia.
Symptoms of Menorrhagia
Some women have heavy periods all the time, from their very first menstrual flow. Others may start to experience heavy periods after having normal periods for years or decades.
Signs and symptoms of menorrhagia include:
- Soaking through one or more sanitary pads or tampons every hour for several consecutive hours
- Needing to use double sanitary protection to control your menstrual flow
- Bleeding for longer than a week
- Needing to wake up to change sanitary protection during the night
- Passing blood clots larger than a quarter
- Restricting daily activities due to heavy menstrual flow
- Constant lower abdominal and pelvic pain
- Symptoms of anemia, such as tiredness, fatigue or shortness of breath
Causes
A number of conditions may be responsible for menorrhagia, some of which includes:
- Hormone imbalance: Every month, a lining builds up inside your uterus (womb) known as endometrium, which you shed during your period. If a hormone imbalance occurs, the endometrium develops in excess (or making the lining too thick), which sheds by way of heavy menstrual bleeding.
- Fibroids and polyps: These growths, which are typically noncancerous appear during your childbearing years. They can form in or on the uterine wall and can cause excessive bleeding.
- Ovarian dysfunction: If your ovaries don’t release an egg (ovulate) during a menstrual cycle (anovulation), your body doesn’t produce the hormone progesterone, as it would during a normal menstrual cycle. This leads to hormone imbalance and may result in menorrhagia.
- Certain IUDs: Many women use a small intrauterine device (IUD) for birth control. Menorrhagia is a well-known side effect of it. If your IUD doesn’t contain hormones, it may make your periods heavier.
- Adenomyosis: This condition occurs when the inner lining of the uterus (endometrium) breaks through the wall of the uterus and causes heavy bleeding and painful periods.
- Pregnancy-related complications: Ectopic pregnancy (when the fertilized egg implants outside the uterus) and miscarriage can cause heavy menstrual bleeding.
- Pelvic inflammatory disease: This is an infection of the reproductive organs that can have severe complications. Symptoms of this condition include heavy bleeding.
Other causes of menorrhagia include some female cancers like cancer of the uterus, cervix, or ovaries, bleeding disorders, and underlying medical conditions like liver or kidney disease.
Diagnoses for menorrhagia
To make a diagnosis of menorrhagia, your Ob/Gyn will require to discuss your medical history. Physical examinations that can help to evaluate for menorrhagia include:
- Blood tests to check for disorders such as anemia, thyroid disease, and clotting disorders
- Ultrasound to evaluate the pelvic organs including the uterus, ovaries, and pelvis
- Pap smear test to evaluate for cervical infection, inflammation, dysplasia, and cancer
- Endometrial biopsy to test the lining of the uterus for cellular abnormalities and cancer
Sometimes additional tests are still required to understand the cause of bleeding, including:
- Sonohysterogram to check for problems in the lining of the uterus
- Hysteroscopy to check for polyps, fibroids or other problems
- Dilation and curettage (“D&C”). This test can also treat the cause of the bleeding.
Treatment options
Treatment for menorrhagia depends on various factors such as how serious your bleeding is, the cause of the bleeding, your health, age, and medical history.
Depending on the case, your doctor might opt for treatment options which include:
Medications
Medications are typically the first method of treatment for menorrhagia. Medical therapy for menorrhagia may include:
- Iron supplements to treat anemia
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), may help reduce menstrual blood loss. NSAIDs have the added benefit of relieving painful menstrual cramps (dysmenorrhea).
- Oral contraceptives to regulate the menstrual cycle and reduce episodes of excessive or prolonged menstrual bleeding.
- Tranexamic acid, or Lysteda taken at the time of bleeding to help reduce blood loss.
- Oral progesterone to treat hormonal imbalance and reduce bleeding.
- Hormonal IUD (Liletta, Mirena), an intrauterine device that releases a type of progestin called levonorgestrel, to thin the lining of the uterus, reducing bleeding and cramping.
Surgical interventions
You may need surgical treatment for menorrhagia if medical therapy does not help. Surgical procedures include:
- Myomectomy. This surgery involves surgical removal of uterine fibroids. It is performed hysteroscopically through the vagina or laparoscopically through the abdomen (via small minimally invasive incisions).
- Endometrial ablation. This procedure involves a variety of methods including radiofrequency, destroys or removes much of the uterine lining to reduce bleeding. After endometrial ablation, most women have much lighter periods.
- Hysterectomy. This surgery, which involves removing the uterus, cures heavy bleeding. It is a permanent procedure that causes sterility and ends menstrual periods. Hysterectomy can be performed several different ways, including using minimally invasive techniques like a vaginal or laparoscopic hysterectomy.
- Dilation and curettage (D&C). This is a surgical procedure where your cervix is opened up and the lining of the uterus is scraped off to reduce menstrual bleeding.
