Every woman’s menstrual cycle is as unique as she is and what is ‘normal’ for one, may not be ‘normal’ for another. However, at times, recurrent period problems can disturb a woman’s lifestyle, affecting her job, and sexuality and causing severe anxiety.

Heavy, prolonged, or irregular periods should be a cause for concern. Some women may also bleed between their periods (intermenstrual bleeding) or after sexual intercourse (postcoital bleeding). All these issues may require further investigation by a specialist gynecologist.

Heavy Menstrual Bleeding (HMB)/Menorrhagia

Heavy menstrual bleeding is a common complaint among women, however, most women don’t experience such severe symptoms that their daily routine is affected. If you are experiencing any of the following symptoms, you should seek help;

  • Bleeding longer than a week or having to restrict daily activities due to a heavy menstrual flow
  • Soaking through your usual pads/tampons each hour for 2 or more hours
  • Passing large blood clots
  • Needing to wake up during the night to change sanitary pads
  • Symptoms of anemia – tiring easily, shortness of breath, fainting episodes or palpitations

Causes Of Menorrhagia

  • Hormone imbalance – the build-up of the endometrium (the lining of the uterus/womb) is not sufficiently regulated by estrogen and progesterone hormone levels. This may arise from obesity, insulin resistance, thyroid problems, or Polycystic Ovary Syndrome (PCOS).****
  • Anovulation – This is typical among teenage girls in the first years of ovulation and proceeding the menopause, there may be a failure of ovulation. Failure to ovulate means that no progesterone hormone is released and the lining of the womb is unprepared for menstruation, resulting in heavy bleeding.
  • Uterine Fibroids – Uterine Fibroids are non-cancerous growths in the womb. Typically they are diagnosed during the reproductive years and result in painless heavy bleeding.
  • Uterine Polyps – These are small grape-like, non-cancerous growths on the lining of the uterus, which are typically seen in older women.
  • Adenomyosis – Glands from the lining of the womb become deeply embedded in the uterine muscle, causing painful heavy periods.
  • Medications  – Misuse of hormonal medication like the birth control pill or use of blood thinners like warfarin may lead to HMB
  • Intrauterine Device (IUD) – HMB is a common side effect of using the Copper T device
  • Uterine and Cervical Cancer – This is especially so if a woman has an abnormal Pap smear test or is postmenopausal or has intermenstrual bleeding.

After a careful history and pelvic examination, additional tests may be required to confirm your diagnosis. Initially, a blood test may be requested to determine how anemic you are. An ultrasound could be performed in the office to look for abnormalities in your womb or ovaries.

Further testing may be required, including a pap smear or tiny biopsy of the lining of the womb (pipelle) to rule out any pre-cancerous or cancerous changes.

Should the routine ultrasound scan or a special saline infusion ultrasound reveal any polyps within the womb then a hysteroscopy is advised. During this procedure, a small camera is passed from the vagina into the womb and the polyps are removed.

Based on your diagnosis and after consideration of your medical status, the degree to which your quality of life is affected, fertility aspirations, and the effectiveness of the treatment, a personalized treatment plan would be devised.

The following are some of the treatment options that might be applicable to your unique condition.
Treatment options include:

  • Mefenamic Acid – is an anti-inflammatory pain killer which may reduce menstrual blood loss by 40%.
  • Tranexamic Acid – reduces blood loss by slowing down anti-clotting activity in the womb.
  • Oral Contraceptives – Provides birth control, regulates the cycle, and also reduces menstrual bleeding by 40%. Not suitable for very overweight patients
  • Oral Progesterone – used to initiate menstrual flow if the menses is very infrequent
  • Hormonal IUD – A small T-shaped intrauterine device that releases a progesterone-type hormone. This thins the lining of the womb, reduces blood flow, provides birth control, and reduces the risk of uterine cancer
    Iron Supplements for those who are suffering from anemia

Should these methods fail or are unsuitable to you then more invasive treatment options might be of benefit. These include:

  • Dilation and Curettage (D&C) – Known as a “scrape out”, this procedure is not recommended for treatment but is used to diagnose why the above medical treatments might have failed.
  • Uterine Artery Embolisation – this is used when menorrhagia is caused by uterine fibroids. It shrinks uterine fibroids by blocking the uterine arteries and cutting off the blood supply of the fibroids. However, in some cases, they may continue to grow in size.
  • Myomectomy– this involves the surgical removal of uterine fibroids, with the intention of leaving a functional uterus behind. In most cases this may be performed via an open abdominal procedure but may be done laparoscopically or through the vagina and cervix (hysteroscopically) if the fibroids are small.
  • Endometrial ablation – This procedure destroys the lining of the womb using various energy sources such as heat, laser or electrical energy. However, since getting pregnant afterward is associated with many serious complications, reliable or permanent contraception is advised.
  • Hysterectomy – This is the definitive treatment for heavy menstrual bleeding, as the source of the problem is removed. Based on your age and risk factors the ovaries may be removed at the same time.