What is Heavy bleeding (Menorrhagia)

In discussing the causes of heavy bleeding, Know that Heavy bleeding or Menorrhagia is the medical term for unusually heavy or prolonged menstrual periods. Many women have heavy flow days and cramps when they have their period. But Heavy bleeding or Menorrhagia is common, affecting anywhere from 27% to 54% of people who menstruate It is one of the most common gynecological complaints, affecting more than 10 million people in the United States each year.

With Heavy bleeding or menorrhagia, your flow is so heavy that you’ll need to change your tampon or pad every hour for at least an entire day. You also have severe cramps that stop you from doing your usual activities. Women lose an average of 30-40 millimeters of blood. Women with heavy bleeding may potentially lose up to 80 mL and pass blood clots larger than about 2.5cm.

Untreated heavy or prolonged bleeding can stop you from living your life to the fullest. It also can cause anemia. Anemia is a common blood problem that can leave you tired or weak. If you have a bleeding problem, it could lead to other health problems If you soak through a pad or tampon every hour or so regularly, talk with your doctor. They may be able to help.

Causes of Heavy bleeding (menorrhagia)

• Hormone imbalances: Every month, a lining builds up inside your uterus (womb), which you shed during your period. If your hormone levels aren’t balanced, your body can make the lining too thick, which leads to heavy bleeding when you shed the thicker lining. If you don’t ovulate (release an egg from an ovary), this can also throw off the hormone balance in your body, leading to a thicker lining and a heavier period. Things that can lead to hormonal imbalance

1. Ovulation
2. Thyroid disease
3.  Polycystic Ovary Syndrome

• Cancerous and Non-cancerous growths in your uterus: Polyps and Fibroids (non-cancerous) are growths within the lining of your uterus and uterus respectively. Both can make your periods much heavier or make them last longer than they should, There are other cancerous growth that affects your reproductive system that can cause heavy menstrual bleeding such as Uterine and cervical cancer.
• Hormone problems: Every month, a lining builds up inside your uterus (womb), which you shed during your period. If your hormone levels aren’t balanced, your body can make the lining too thick, which leads to heavy bleeding when you shed the thicker lining. If you don’t ovulate (release an egg from an ovary), this can also throw off the hormone balance in your body, leading to a thicker lining and a heavier period.
• Pregnancy Complication: Heavy bleeding can be a warning sign of pregnancy complications, such as; Ectopic Pregnancy this is a rare case where the sperm fertilizes the egg but instead of growing inside the uterus, it grows outside the uterus. Another complication is Miscarriage which is when a baby dies in the womb, this can also cause heavy bleeding, Furthermore  High numbers of cesarean sections can lead to a scar that creates a pocket in your uterus. That pocket can collect blood, which you can later bleed
• Non-Hormonal intrauterine device (IUD): Heavy menstrual bleeding is a common side effect of a non-hormonal IUD. After a few months with your IUD, you may find that bleeding becomes less severe.
• Bleeding Disorder: Roughly 10 to 30 percent of women with heavy periods have a bleeding disorder, such as von Willebrand. These disorders can make it difficult to stop your bleeding.
• Other Medical Conditions: Heavy menstrual bleeding is a symptom associated with various conditions, including bleeding disorders and non-bleeding disorders. Some common medical conditions that can lead to heavy bleeding are:

• • Blood thinners and aspirin.
  • Hormone replacement therapy.
  • Tamoxifen (breast cancer drug).
  • Intrauterine (IUDs).
  • Birth control pills and injectables

Diagnosis

Finding out if a woman has heavy menstrual bleeding often is not easy because each person might think of “heavy bleeding” in a different way. Usually, menstrual bleeding lasts about 4 to 5 days and the amount of blood lost is small (2 to 3 tablespoons). However, women who have menorrhagia usually bleed for more than 7 days and lose twice as much blood. If you have bleeding that lasts longer than 7 days per period or is so heavy that you have to change your pad or tampon nearly every hour, you need to talk with your doctor.

To find out if you have menorrhagia, your doctor will ask you about your medical history and menstrual cycles.

• How old were you when you got your first period?
• How long is your menstrual cycle?
• How many days does your period usually last?
• How many days do you consider your period to be heavy?
• How do your periods affect your quality of life?

Your doctor also will do a pelvic exam and might tell you about other tests that can be done to help find out if you have menorrhagia.

Tests

Your doctor might tell you that one or more of the following tests will help find out if you have a bleeding problem:

• Blood test. In this test, your blood will be taken using a needle. It will then be looked at to check for anemia, problems with the thyroid, or problems with the way the blood clots.
• Pap test. For this test, cells from your cervix are removed and then looked at to find out if you have an infection, inflammation, or changes in your cells that might be cancer or might cause cancer.
• Endometrial biopsy. Tissue samples are taken from the inside lining of your uterus or “endometrium” to find out if you have cancer or other abnormal cells. You might feel as if you were having a bad menstrual cramp while this test is being done. But, it does not take long, and the pain usually goes away when the test ends.
• Ultrasound. This is a painless test using sound waves and a computer to show what your blood vessels, tissues, and organs look like. Your doctor then can see how they are working and check your blood flow.

Using the results of these first tests, the doctor might recommend more tests, including,

• Sonohysterogram. This ultrasound scan is done after fluid is injected through a tube into the uterus by way of your vagina and cervix. This lets your doctor look for problems in the lining of your uterus. Mild to moderate cramping or pressure can be felt during this procedure.
• Hysteroscopy. This is a procedure to look at the inside of the uterus using a tiny tool to see if you have fibroids, polyps, or other problems that might be causing bleeding. You might be given drugs to put you to sleep (this is known as “general anesthesia) or drugs simply to numb the area being looked at (this is called “local anesthesia”).
• Dilation and Curettage (D&C). This is a procedure (or test) that can be used to find and treat the cause of bleeding. During a D&C, the inside lining of your uterus is scraped and looked at to see what might be causing the bleeding. A D&C is a simple procedure. Most often it is done in an operating room, but you will not have to stay in the hospital afterward. You might be given drugs to make you sleep during the procedure, or you might be given something that will numb only the area to be worked on.

READ ALSO:

Treatment

there are major two types of treatment

Drug Therapy Treatment

• Iron supplements. To get more iron into your blood to help it carry oxygen if you show signs of anemia.
• Ibuprofen (Advil). To help reduce pain, menstrual cramps, and the amount of bleeding. In some women, NSAIDs can increase the risk of bleeding.
• Birth control pills. To help make periods more regular and reduce the amount of bleeding.
• Intrauterine contraception (IUC). To help make periods more regular and reduce the amount of bleeding through drug-releasing devices placed into the uterus.
• Hormone therapy (drugs that contain estrogen and/or progesterone). To reduce the amount of bleeding.
• Desmopressin Nasal Spray (Stimate®). To stop bleeding in people who have certain bleeding disorders, such as von Willebrand disease and mild hemophilia, by releasing a clotting protein or “factor”, stored in the lining of the blood vessels that help the blood to clot and temporarily increases the level of these proteins in the blood.
• Antifibrinolytic medicines (tranexamic acid, aminocaproic acid). To reduce the amount of bleeding by stopping a clot from breaking down once it has formed.

Surgical Treatment

• Dilation and Curettage (D&C). A procedure in which the top layer of the uterus lining is removed to reduce menstrual bleeding. This procedure might need to be repeated over time.
• Operative hysteroscopy. A surgical procedure, using a special tool to view the inside of the uterus, can be used to help remove polyps and fibroids, correct abnormalities of the uterus, and remove the lining of the uterus to manage the heavy menstrual flow.
• Endometrial ablation or resection. Two types of surgical procedures use different techniques in which all or part of the lining of the uterus is removed to control menstrual bleeding. While some patients will stop having menstrual periods altogether, others may continue to have periods but the menstrual flow will be lighter than before. Although the procedures do not remove the uterus, they will prevent women from having children in the future.
• Hysterectomy. A major operation requiring hospitalization that involves surgically removing the entire uterus. After having this procedure, a woman can no longer become pregnant and will stop having her period.

Menorrhagia is common among women. But, many women do not know that they can get help for it. Others do not get help because they are too embarrassed to talk with a doctor about their problem. Talking openly with your doctor is very important in making sure you are diagnosed properly and get the right treatment.