Ask Your Doctor: MENORRHAGIA (HEAVY PERIODS)
Many women experience heavy periods resulting in physical and emotional problems which can disrupt everyday life. Menorrhagia is a common cause for women seeing their gynaecologist and, fortunately, there are many effective treatments for menorrhagia.
What is menorrhagia?
Menorrhagia, or heavy menstrual bleeding, is defined as excessive menstrual blood loss which interferes with the woman’s physical, emotional, social and material quality of life, and which can occur alone or in combination with other symptoms. The complaint of heavy menstrual bleeding is highly subjective.
It is difficult to define exactly what a heavy period is because this varies from woman to woman. What is heavy for one woman may be normal for another.
The average amount of blood lost during a period is 30-40 millilitres (ml), with 9 out of 10 women losing less than 80 ml. Heavy menstrual bleeding is 60 ml or more in each cycle.
Although numerous methods of objectively quantifying menstrual blood loss have been described, most are impractical and unlikely to aid management. Assessment is therefore largely made based on its impact on a woman’s quality of life. Pictorial blood loss charts and menstrual calendars are, however, useful tools to aid the monitoring of symptoms.
How do you know you have menorrhagia?
The following signs and symptoms might lead you to believe you have menorrhagia and need to see your doctor:
• When you are having your monthly menses, you soak through one or more sanitary pads or tampons every hour for several consecutive hours
• You have to use double sanitary protection to control your menstrual flow
• You frequently wake up to change sanitary protection during the night
• Your monthly menses lasts longer than a week
• You pass blood clots with menstrual flow for more than one day
• You have to restrict your daily activities due to heavy menstrual flow
• You have symptoms of anaemia, such as tiredness, fatigue or shortness of breath
• You have heavy bleeding between periods or irregular vaginal bleeding
What causes menorrhagia?
In some cases, the gynaecologist might not be able to determine the cause of menorrhagia, but often the cause is found and might be due to one of the following:
Hormone imbalance. This is very common in adolescent women and peri menopausal women.
Uterine fibroids. These non-cancerous growths are very common in women in Anguilla.
Uterine Polyps. These are small, benign growths on the lining of the uterus.
Adenomyosis. This condition occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding and painful menses.
Polycystic ovary syndrome (PCOS) – a common condition that affects how the ovaries work. It causes irregular periods, and when periods return they can be heavy.
Pelvic inflammatory disease (PID) – an infection in the upper genital tract (the womb, fallopian tubes or ovaries) that can cause pelvic or abdominal pain and bleeding after sex or between periods.
Cancer. Rarely, uterine cancer, ovarian cancer and cervical cancer can cause excessive menstrual bleeding.
Inherited bleeding disorders. Some blood coagulation disorders — such as von Willebrand’s disease – can cause abnormal menstrual bleeding.
Medications. Certain drugs, including anti-inflammatory medications and anticoagulants, can contribute to heavy or prolonged menstrual bleeding.
Other medical conditions. Several other medical conditions, including thyroid problems, endometriosis, and liver or kidney disease, may be associated with menorrhagia.
Making the diagnosis
If you are having very heavy menstrual bleeding see your doctor. Your doctor or gynaecologist will take a complete clinical and menstrual history, and carry out a complete physical examination which might include a pelvic exam. Various blood tests might be needed as well.
If an underlying cause of your heavy periods is not found, you may have an ultrasound scan done as well. This imaging method uses sound waves to produce images of your uterus, ovaries and pelvis. Other special investigations might be needed in selective patients.
Once a diagnosis is confirmed, specific treatment for menorrhagia is started and this is based on several factors, including:
• Your overall health and medical history
• The cause and severity of the condition
• Your tolerance for specific medications, procedures or therapies
• The likelihood that your periods will become less heavy soon
• Your future childbearing plans
• Effects of the condition on your lifestyle
• Your opinion or personal preference
Various medications are available for successfully treating menorrhagia, but you may need surgical treatment for menorrhagia if drug therapy is unsuccessful.
Some women lose an excessive amount of blood during their menstrual periods. While not life threatening in most women, in a few women it might lead to complications or might be associated with some serious underlying disease. Women with heavy menstrual periods are therefore encouraged to see their doctor to be evaluated and treated.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty-two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).