Heavy Bleeding during Period
Menorrhagia is a condition of having prolonged and heavy bleeding during period. This is a common gynecologic concern that affects almost 30% of women. This is often associated with other conditions; however, some cases are still without a known cause. Women having menorrhagia experience a variety of symptoms depending on the primary cause. Treatment and medications are also diverse as they target the root cause of heavy bleeding during period.
What is Menorrhagia?
The normal menstruation cycle is 25 to 35 days. The bleeding period would only last for 5 days with an average blood loss of 30 to 80 mL per menstruation. One can measure blood loss simply by counting the used sanitary pads. Generally, a fully soaked sanitary pad can hold about 5 mL of blood. Menorrhagia is considered when blood loss exceeds 80 mL and bleeding period lasts for 7 days or more.
Some cases of heavy bleeding during period are still considered idiopathic. Most of which are just symptoms of other more complicated conditions. It is imperative that cause will be distinguished to have proper medical therapy.
• Coagulation problems – One cause of heavy bleeding during period is coagulation problems. Normally, endometrial lining is shed exposing blood vessels. Blood loss is reduced through proper coagulation process. Hemophilia, Von Willebrand disease and other platelet disorders can cause excessive blood flow. Anti-coagulant medications including warfarin and aspirin can also affect the amount and duration of blood flow.
• Hormonal imbalance – Heavy bleeding during period can also be caused by hormonal imbalance. Estrogen is responsible for thickening of the endometrial lining. This is to ready the uterus in case fertilization occurs. However, if no fertilization takes place, estrogen level drops and signals the body to shed the accumulated lining. If estrogen level stays high, uterine wall does not cease to build up causing irregular shedding.
• Hypothyroidism – can also cause menorrhagia. This happens when there is less or absent thyroid hormone available for body processes. This causes bodily functions to slow down including the coagulation process.
• Vitamin deficiency – Another cause for heaving bleeding during period is vitamin deficiency. This primarily concerns Vitamin K which is a necessary component in blood clotting. A decreased level of Vitamin K in the blood stream means slower clotting process. Studies have also shown that Vitamin K is an antagonist of estrogen.
• Deviation in uterine structure – can also cause excessive bleeding. Endometriosis and fibroids is the abnormal growth of fibrous tissues within or around the uterus. If this progresses, it adds up to the normal uterine lining thickening. During the normal process of menstruation, the fibrous tissues are irritated.
• IUD – Uterine irritation can also be caused by intra-uterine contraceptive devices (IUD’s). IUD’s are inserted in the uterine cavity to prevent the sperm from meeting a mature ovum. Menstruation can be abnormal for 2 to 3 months after introduction of IUD since the body is still adjusting. However, if the woman complains that it interrupts activities of daily living, the device has to be taken off.
• Stress – Lastly, heavy bleeding during period can be caused by physical strain and psychological stress. Although it is not clearly defined, many studies have linked fatigue and tension to abnormal menstruation cycle and bleeding period.
Diagnosis of heavy bleeding during period
In order for a gynecologist to know the proper treatment regimen, laboratory and diagnostic tests are utilized. Medical and menstrual history is carefully taken in order to identify certain risk factors. Anovulation or missed ovulation for one cycle is prevalent among young females and pre-menopausal women. History of estrogen and progesterone medications can also increase possibility of menorrhagia.
Pelvic physical examination is done to evaluate general reproductive health. Assessment of the rectal area is crucial to rule out hemorrhoids as cause of bleeding. Blood tests are done to determine anemia, infection, clotting time and hormone blood levels. Pap smear and endometrial biopsy are the collection and assessment of cervical and uterine cells respectively. This will show signs of irritation, inflammation and infection. It could also detect cancerous cells. Ultrasound is an imaging method utilizing sound waves to observe the reproductive organs including the ovaries and uterus.
Medical and surgical intervention for heavy bleeding during period depends on several factors. This would include the general well-being of the woman, gravity of cause, current lifestyle, childbearing plans and personal choice.
Medications include nonsteroidal anti-inflammatory drugs to ease cramping and pain. Iron supplements are also recommended since anemia is the most common complication of menorrhagia. Oral contraceptives serve to control pregnancy and regulate menstrual cycle duration. While oral progesterone works to lessen accumulation of the endometrial lining.
If the medications fail to show improvement of symptoms, surgical intervention could be done. The most common procedure is Dilatation and Curettage wherein the uterine lining is directly scraped or suctioned. The thinner the lining to be shed the lesser the blood loss. This is fairly successful in several cases. However, menorrhagia can occur after some time and the procedure will have to be repeated.
Endometrial ablation is the permanent destruction of the uterine walls. This can significantly reduce the blood flow and pain felt. However, this would also reduce the chances of getting pregnant since there is less tissue for the embryo to implant.
Polyps, tumors or benign cysts can be the culprit for heavy bleeding during period. If this is the case, endometrial resection can be done. This will remove any abnormal growth in the uterine wall. This would also affect rate of successful pregnancy.
Hysterectomy is the last option to treat menorrhagia. This procedure will permanently remove the uterus, cervix and sometimes even the ovaries, thus, pregnancy is impossible to achieve after the procedure. Menstrual cycle would also stop prematurely. This requires hospitalization with general anesthesia during the surgical procedure.
• Hormone therapy
If proven that heavy bleeding during period is caused by hormonal imbalance or nutritional deficiency, treatments are directed toward these. Hormonal therapy is often imposed until hormone blood levels are adequate. Vitamin supplements are also utilized to correct menorrhagia.
• Lifestyle changes
Treatment therapy would also include changes in the lifestyle of the women suffering from menorrhagia. First of all, get some rest. Excessive blood loss affects mental processes including headache and dizziness. Do keep a record of your menstrual cycle. Each woman has her own pattern of menstrual cycle. One must familiarize this so changes can be immediately reported. Lastly, have a balanced diet and adequate exercise.
Heavy menstruation during period is one the most common concerns of women worldwide. It’s important to know the main problem since menorrhagia is only a symptom of other conditions, hence, can only be treated once an exact cause is established.