Menstruation is a normal and natural part of every woman’s life, marking a fundamental aspect of reproductive health. While menstrual cycles vary widely, some individuals will experience lighter, shorter periods, while others face heavier, more prolonged bleeding.

Heavy menstrual bleeding, also known as menorrhagia, is a common concern that affects many women and can significantly impact daily life.

Understanding the causes, symptoms, and treatment options for heavy menstrual bleeding is essential for managing this condition effectively and maintaining your quality o f life. In this article, we explore the various factors contributing to heavy menstrual bleeding and provide insights into treatment and management.

What Is Heavy Menstrual Bleeding?

Heavy menstrual bleeding, or menorrhagia, is one of the most common gynaecological complaints, affecting millions of people around the world. It is believed that 1 in 4 women of reproductive age may be affected by heavy menstrual bleeding, of which about a third do not know if there are treatments available.

Traditionally heavy menstrual bleeding is defined as over 80mL of blood loss per menstrual cycle, however individuals may have symptoms with less volume than this and treatment guidelines do not need to quantify amount of blood loss for a diagnosis.

Individuals with heavy menstrual bleeding may find that their periods last longer than 7 days, or they may experience exceptionally heavy bleeding that requires them to change tampons or pads every hour for several hours in a row. Some might even need to wear more than one pad simultaneously or change their menstrual products throughout the night to manage the flow.

Symptom Overview:

• Soaking though one or more period product every hour for several hours
• Needing double protection to manage flow
• Getting up at night to change sanitary products
• Bleeding though clothing and sheets
• Bleeding for more than a week
• Passing large blood clots
• Limiting daily activities or work attendance because of heavy menstrual flow
• Impacting relationships with partners
• Feeling tired, fatigued and short of breath due to blood loss

Heavy menstrual bleeding is more than just an inconvenience for many; it can deeply impact daily activities, leading to discomfort, disruption, and in some severe cases, other health concerns.

The Importance of Healthcare

Despite the persistent stigma surrounding periods and menstruation, heavy bleeding is a common issue that affects many individuals, disrupting everything from work to social activities and overall well-being.

There is still a significant gap that exists in the awareness and diagnosis of this condition, with only a small percentage of women receiving a formal diagnosis. While heavy menstrual bleeding is often perceived as a manageable inconvenience, it can sometimes signal a more serious underlying health problem that requires professional attention.

Understanding and addressing heavy bleeding is crucial for several reasons. Receiving appropriate healthcare is crucial for addressing heavy menstrual bleeding. A better-informed body is a healthier body, and understanding this condition can lead to more effective management and treatment options.

What Causes Menorrhagia?

Abnormally heavy or prolonged menstrual bleeding, can stem from a variety of underlying causes. These typically fall into three broad categories: uterine-related problems, hormone-related issues, and other underlying illnesses or disorders.

Identifying the exact cause of menorrhagia is crucial for effective treatment. Understanding these underlying factors helps in determining the most appropriate management strategies and addressing any serious health concerns.

• Uterine Fibroids: Noncancerous growths in the uterus that can cause heavy bleeding, discomfort and painful periods.
• Uterine Polyps: Small, benign growths on the lining of the uterus that can contribute to excessive bleeding.
• Adenomyosis: A condition where the tissue that lines the uterus grows into the uterine wall, leading to heavy and painful periods.
• Cancer: Though less common, cancers of the uterus or cervix can present with abnormal bleeding.
• Irregular Ovulation: Disruptions in the normal ovulation cycle can lead to heavier and irregular bleeding. This is most common during puberty and peri-menopause where hormones are in a state of flux. Excessive stress or weight loss is also a contributing factor.
• Inherited Bleeding Disorders: Conditions like haemophilia or von Willebrand disease that affect blood clotting can lead to heavier menstrual bleeding.
• Iatrogenic: Some medical interventions or medications can contribute to heavy bleeding for instance the use of hormonal therapy or blood thinners for the treatment of  other conditions.
• Other / Not classified: There are some conditions that are poorly defined or extremely rare that can contribute to heavy menstrual bleeding.

Read More: What You Need To Know About Endometrial Polyps

How Is Heavy Menstrual Bleeding Diagnosed?

Diagnosing heavy menstrual bleeding involves a thorough and thoughtful approach to understanding the underlying cause and the best way to manage it. Here’s what you can expect during the diagnostic process:

Medical History and Symptom Review

Your healthcare provider will start by asking about your medical history and details about your menstrual cycles. They’ll want to know how long you bleed each month, how heavy your flow is, and how often you need to change your menstrual products. This information helps them gauge the severity of your symptoms and how it’s affecting your daily life. Keeping a menstrual diary in the months leading up to your consultation can be helpful.

Physical Examination

A physical exam is usually performed which might include a pelvic exam to assess the health of your reproductive organs and look for any abnormalities that could be contributing to your heavy bleeding.

Diagnostic Tests and Procedures

To get a clearer picture of what’s causing your symptoms, your doctor might recommend some tests or procedures, such as:

• Blood Tests: These help check for anaemia or other conditions like thyroid disorders or blood clotting issues.
• Cervical screening Test: This is used to screen for cervical cancer.
• Endometrial Biopsy: A small sample of the lining of your uterus can be taken to check for issues such as abnormal cells or cancer.
• Ultrasound: This imaging test allows doctors to see inside your uterus and surrounding organs to identify conditions like fibroids or polyps.
• Hysteroscopy: A thin, flexible tube with a camera is inserted into the uterus to directly view the inside and, if needed, treat any abnormalities.

Additional Assessment

Depending on the results from these tests, you may need further evaluation. This might include more specialised tests or referrals to other specialists to ensure a complete understanding of your condition and to develop the most effective treatment plan.

Treating Heavy Menstrual Bleeding

Choosing the right treatment for heavy menstrual bleeding involves a thoughtful discussion with your healthcare provider about your specific needs and circumstances. Together, you can explore the options that best align with your health goals and lifestyle.

The treatment plan will be tailored based on:

• Your Overall Health and Medical History
• The Cause and Severity of the Condition
• Tolerance to Medicines or Procedures
• Future Pregnancy Plans
• Impact on Lifestyle
• Personal Preferences

Treatment Options

Medications

1. Hormonal Contraceptives: Options like the contraceptive pill, Implanon, or an intrauterine device (IUD) can help regulate menstrual flow and reduce bleeding.
2. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These can reduce menstrual bleeding and relieve pain.
3. Tranexamic Acid: This is a medication that is taken each month when bleeding to help reduce the amount of bleeding.
4. Iron Supplements: Prescribed to treat anaemia that present due to heavy bleeding.

Surgical Options

1. Hysteroscopic Surgery: Hysteroscopic surgery is a minimally invasive procedure used to examine and treat conditions within the uterine cavity. It involves inserting a thin, lighted tube called a hysteroscope through the vagina into the uterus to obtain a sample of the endometrium and remove polyps or fibroids.
2. Uterine Artery Embolization: A procedure that cuts off blood supply to fibroids or polyps to reduce bleeding.
3. Myomectomy: A surgery to remove uterine fibroids while preserving the uterus. This can be done via hysteroscopy or laparoscopy (key-hole surgery via the abdomen) depending on the size and location of the fibroid.
4. Endometrial Ablation: A procedure that ‘burns’ the lining of the uterus to reduce or stop bleeding.
5. Hysterectomy: A surgical procedure to remove the uterus, which is usually considered when other treatments have not been effective or when there are other serious underlying conditions.

Finding Relief for Heavy Menstrual Bleeding

Heavy menstrual bleeding can be a challenging and disruptive condition, but understanding its causes and exploring effective treatments can lead to significant relief and an improved quality of life. With a variety of treatment options available, from medications and contraceptives to advanced surgical procedures, there is hope for managing and overcoming this condition.

For those seeking expert care, Dr Nargis Noori, a distinguished Obstetrician and Gynaecologist, offers compassionate care tailored to your unique needs. With a rich academic background, Dr Noori combines leading techniques with personalised treatment plans to address menstrual disorders.

If you’re struggling with heavy menstrual bleeding, reach out today. Her expertise and innovative approach to treatment can help you regain control and improve your health. Contact us today to schedule an appointment and take the first step towards a healthier, more comfortable life.