Menorrhagia; Over Bleeding During Menstrual Periods.

A person with menorrhagia is one who experiences bleeding that lasts longer than 7 days or very heavy bleeding that causes them to soak through one or more tampons or pads every hour for several hours in a row.

Our average blood loss during menstruation is about two – three table spoons equating to 30–45 milliliters, over 4–5 days. However, a person with menorrhagia loses more the 80mls.

Heavy menstrual bleeding is very common, and about 33% of females seek treatment for it. The statistics signify a more serious health problem.

Untreated heavy bleeding can cause anemia, a condition that occurs when the blood does not carry enough oxygen to the rest of the body. The symptoms can include fatigue, weakness, and chest pain.

The symptoms of menorrhagia can include;

• A heavy menstrual flow that soaks through one or more sanitary pads or tampons every hour for several consecutive hours.
• Menstrual flow or bleeding lasting more than a week with the need to change pads or tampons in the middle of the night.
• The passage of large size blood clots.
• Symptoms of anemia, including fatigue and shortness of breath
• Constant lower abdominal and pelvic pain
• The inability to perform regular daily activities because of bleeding
• If bleeding interferes with daily life or emotional well-being, it is advisable to seek help from a doctor. The treatment options for menorrhagia will depend on the individual case and the underlying cause of bleeding.

Abnormally heavy or prolonged menstrual bleeding has many causes. These causes of menorrhagia fall under three major categories: uterine-related problems, hormone-related problems, and other illnesses or disorders. The causes include;

• Uterine fibroids: These noncancerous tumors grow either inside or outside the uterine wall causing heavy bleeding or painful periods.
• Uterine polyps: Polyps are overgrowths of endometrial tissue, which is the type of tissue that lines the inside of the uterus.
• Irregular ovulation: If hormonal disruptions cause irregular ovulation, the lining of the uterus can build up and become too thick. When this lining eventually sheds during menstruation, heavy bleeding can occur. This is common during puberty and peri menopause. It can sometimes occur due to weight loss or stress or as a symptom of certain medical conditions, like PCOS.
• Adenomyosis: In people with this condition, tissue from the lining of the uterus becomes embedded in the muscle of the uterus. It can cause painful and heavy menstrual bleeding.
• Non hormonal intrauterine device (IUD): This type of birth control device sits in the uterus and can cause heavy bleeding.
• Pelvic inflammatory disease (PID): This infection of the reproductive organs results from untreated sexually transmitted diseases.
• Pregnancy-related complications: Pregnancy-related problems, such as pregnancy loss  or an ectopic pregnancy can cause abnormal bleeding.
• Cancer: Uterine, cervical, and ovarian cancers affect the reproductive system and cause heavy bleeding.
• Inherited bleeding disorders: Examples include Von Willebrand’s disease and platelet function disorders.
• Medications: Certain anti-inflammatory and anticoagulant drugs can lead to heavy bleeding.
• Other health conditions that can cause menorrhagia include thyroid disorders, endometriosis, and liver or kidney disease.

Tests that can help diagnose menorrhagia include:

1. Blood tests to check for anemia, thyroid disease, and clotting disorders.
2. Pap smear to evaluate for cervical infection, inflammation, and cancer.
3. Endometrial biopsy to test the lining of the uterus for cellular abnormalities and cancer
4. Ultrasound to evaluate the pelvic organs, including the uterus, cervix, and ovaries
5. Sono hysterogram, which involves injecting fluid into the uterus and using ultrasound to evaluate for abnormalities
6. Hysteroscopy, which involves inserting a camera into the uterus to inspect the lining for abnormalities
7. Dilation and curettage, which a doctor may use to detect and treat abnormalities
8. Keeping a diary of the length and heaviness of menstruation and sharing the information with the doctor may help with the diagnosis.
9. The doctor will consider the person’s age, general health, and medical history, as well as their preferences and needs regarding menstruation. For example, while some people may want a treatment that stops menstruation completely, others may prefer to keep having a period.

Drug therapy options include;

• Iron supplements to treat anemia
• Birth control pills to make periods more regular, reduce bleeding, or stop bleeding completely
• Prescription medication that a person takes each month at the time of bleeding to help reduce blood loss
• Hormone therapy with drugs containing trusted source estrogen, progesterone, or both to reduce the amount of bleeding
• Planting a hormonal IUD in the lining of the uterus, which can help reduce bleeding and cramping
• Medications that help treat the underlying cause of heavy menstrual bleeding

Surgical interventions

Several surgical procedures are available to relieve the symptoms of menorrhagia. Considering the cause and extent of the bleeding, the age and health of the person, and their personal preference and expectations, the doctor will determine which, if any, surgical intervention is most appropriate.

The options may include:

• Dilation and curettage: Dilation and curettage is a surgical procedure in which a surgeon removes a layer of the uterine lining to reduce menstrual bleeding.
• Uterine artery embolization: This procedure treats fibroids by blocking the arteries that supply them with blood.
• Operative hysteroscopy: A surgeon will insert a small camera into the uterus to evaluate the lining. If necessary, they will remove any polyps and the uterine lining to reduce heavy menstrual flow.
• Focused ultrasound ablation: This procedure uses ultrasonic waves to kill fibroid tissue.
• Myomectomy: This procedure removes uterine fibroids or stops heavy bleeding without removing the uterus.
• Endometrial ablation: A surgeon will permanently destroy the lining of the uterus to stop or reduce menstrual bleeding.
• Hysterectomy: This surgical procedure removes the uterus, cervix, and, sometimes, the ovaries. In doing so, it permanently stops menstruation and removes the ability to become pregnant.

If a person’s periods last longer than 7 days or interrupt daily life, they should contact a doctor. In some cases, a person’s symptoms may be due to other types of irregular bleeding. These include:

• Polymenorrhea: This is menstruation that happens too often.
• Oligomenorrhea: This term refers to menstrual bleeding that is infrequent or inconsistent.
• Metrorrhagia: This irregular bleeding happens between cycles and does not appear to be linked to menstruation.
• Postmenopausal bleeding: This occurs during menopause, meaning that a person experiences it more than a year after their last period.

As these types of bleeding do not have strict criteria for diagnosis, doctors now refer to them less frequently. However, it may still be beneficial for a person to know about different menstrual bleeding patterns.

Summary of facts.

Anyone experiencing menstrual bleeding that lasts longer than 7 days or requires them to change their pad or tampon every hour for multiple hours in a row should speak with a doctor. The doctor can help diagnose the cause and provide treatment.

Heavy menstrual bleeding can be due to hormone-related causes or medical conditions, including delayed ovulation, cancer, PID, and inherited bleeding disorders.

Sometimes, heavy bleeding is a side effect of medications or results from pregnancy-related complications.

Treatments to reduce abnormally heavy bleeding depend on the underlying cause, but they can include hormonal birth control, hormonal therapy, and drugs that reduce the amount of bleeding. Sometimes, a doctor may recommend a surgical procedure to reduce or stop bleeding if other treatments do not prove effective.

Signs you’re losing too much blood during your period include feeling weak, dizzy or lightheaded, pale skin, have trouble breathing, very painful cramps, changes in consciousness and shortness of breath. A period is considered heavy when you bleed for more than seven days, pass large clots, or have to change your pad or tampon every one to two hours. These could be signs that your body is losing too much blood too quickly, or that there’s a more serious issue that needs urgent care.

Heavy bleeding can affect your energy, daily activities, and long-term health—especially if it leads to anemia or other complications. The good news is, there are many treatments available that can help. If you’re unsure but feel that something isn’t right, it’s always safer to get checked—especially if your symptoms come on suddenly or feel more intense than usual.

Heavy menstrual bleeding can happen for many reasons. Some are harmless and treatable, while others may require more serious attention i.e Surgery.  Your provider can help you weigh the pros and cons of each option. You don’t have to live with heavy bleeding—there are safe and effective ways to manage it.