Also called as Menorrhagia, excessive bleeding during menstruation is said to occur if the woman in question tends to experience shedding for more than 7 days (a normal menstrual cycle will last between 4-7 days) or heavy bleeding that requires her to change tampons (or) pads once every two hours or so.
The average menstrual period for a woman in normal circumstances is about 28 days where she loses about 40 ml of blood during the course of 7 days. A woman is said to be suffering from menorrhagia if she loses more than 80 ml of blood during her period. If that happens on a regular basis, the woman stands high chances of contracting other health related ailments like a weakened immune system or anemia etc.
Common Causes and Symptoms of Menorhrhagia
Excessive bleeding during menstruation can be caused by a number of reasons. The more common reasons for the condition, however, include anovulation (failure to ovulate once every month which would cause the endometrial lining to thicken), presence of polyps or fibroids in the uterus, cervix or vagina (detachment from the inner walls can cause bleeding), and existing bleeding disorders that lead to excessive bleeding throughout the body.
Some of the more common symptoms of Menorrhagia that one has to look out for include heavy vaginal bleeding that would require frequent change of tampons or pads (once for every 2 hours), combined use of pads and tampons to prevent overflow, necessity to change tampons or pads even in the night, prolonged menstrual bleeding (lasting for more than 7 days) and presence of blood clots (bigger than 1 inch) during bleeding. A woman may also suffer from Menorrhagia if she develops anemic symptoms (caused by iron deficiency) during menstruation.
Diagnosis of Menorrhagia
Before starting an appropriate treatment for excessive menstrual bleeding, the doctor would take some tests to find out the exact cause of the condition. These tests would usually include physical and pelvic exams, blood tests that would check for conditions like anemia, thyroid or bleeding disorders etc., a pelvic ultrasound that relays back images of the uterine and cervical regions (useful to spot polyps, fibroids or other growths that may be causing the condition), a hysteroscopy to look inside the uterus (with a light and camera) for problems and an endometrial biopsy (taking a sample of the tissue inside the uterus).
The specific treatment chosen for the condition would depend on the cause for the same and other factors like the patient’s body conditions, constraints and existing medical ailments if any. In certain cases, the treatment for excessive menstrual bleeding would also differ according to the patient’s preferences with regard to pregnancy and childbirth.
Effective Treatment Options for Menorrhagia
In most cases, the doctor would start treatments with standard medications, and would proceed to the next level (i.e. shots, implants and surgery) if the medications do not have any effect on the condition.
Hormonal Birth Control Pills
These are usually prescribed to help reduce excessive menstrual bleeding and offer relief from severe menstrual cramps as well. The pills are usually taken daily for 3 continuous weeks with the patient getting her periods on the 4th week. The entire cycle (1 month = 3 weeks of pills+1 week of waiting for the period to begin) needs to be continued for almost 3 months or more depending on the severity of the condition.
The patient would most probably start seeing positive results (reduced menstrual bleeding) after this timeframe. Although birth control pills are favored by most women, the doctor may prescribe other options like skin patches and vaginal rings based on individual preferences and constraints.
Non Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are often used to reduce painful cramps and excessive bleeding during menstruation. They are inexpensive, do not cause any harmful side effects and can be obtained over the counter without a prescription (most of them). Common examples include ibuprofen and mefenamic acid which need to be taken during the menstrual period (between 1-7 days of the period).
NSAIDs can also be used in conjunction with other medications and treatments used to treat menorrhagia. However, they are not that effective when compared to hormonal birth control pills and other treatments available for the condition. Therefore, they can most probably used to offer temporary relief from excessive bleeding and cramps during menstruation.
These are usually prescribed for women with severe menstrual bleeding. When consumed, these drugs work by targeting the body’s clotting system and effectively reduce menstrual bleeding within 2-3 hours. These drugs do not interfere with pregnancy as well and need to be taken only a few days in a month. Common examples of anti-fibrinolytic medications used to treat excessive menstrual bleeding include aminocaproic acid and tranexamic acid.
Unlike NSAIDs, anti-fibrinolytic medications cannot be used along with hormonal birth control pills unless recommended by the doctor. In addition to common side effects like headaches and muscle cramps, unsupervised use of these drugs (with hormonal pills) can lead to blood clots, heart attacks and strokes etc.
These pills are usually recommended for women who experience anovulation (failure to ovulate every month). The pills work on the uterine lining and prevent it from thickening. The pills need to be taken daily for about 10 days in a month. Periods will usually start within 2 weeks of the last dose every month. Progestin pills do not cause harmful side effects and do not cause any hindrances to pregnancy and childbirth.
Gonadotropin Releasing Hormone Agonists (GnRH)
These medications are usually prescribed for women who want to reduce or stop menstrual bleeding ahead of a surgery. These agonists simulate menopause by temporarily switching off the ovaries and stopping ovulation. These medications can be taken for a time period of up to 6 months to reduce (or stop) excessive menstrual bleeding. However, they need to be stopped after 6 months as prolonged use can lead to side effects like weak bones.
Medroxyprogesterone Acetate Shots
This particular medication for menorrhagia is delivered as an injection once in every 3 months or so. The medication resembles a progestin pill and provides a long term solution to the problem.
When administered, the drug effectively reduces severe menstrual bleeding. However, the shot can prevent pregnancy as a result of which it is mostly prescribed for women who do not want to get pregnant for the next 6 months or so.
Hormonal Intrauterine Devices
Also called as Mirena, the hormonal intrauterine device is an IUD (intra uterine device) that is fitted into the uterus by the doctor. When properly fitted, the device would start releasing the progestin hormone into the uterus. This in turn can act against the excess estrogen present in the uterus (usually responsible for the thickening of the endometrial lining) and reduce the effects of the latter (including heavy menstrual bleeding).
A hormonal intrauterine device would effectively curb excessive menstrual bleeding to a great extent. A properly fitted device can perform perfectly for almost 5 years. However, the device would prevent pregnancy and would need to be opted for only if the patient does not wish to conceive for the next 6 months or so.
Similar to the hormonal uterine device, the hormonal implant is a small device that is implanted under the skin. Usually placed in the upper inner arm, the device would be the size of a matchstick, hardly causing any discomfort to the patient.
Once placed properly, the implant would start releasing the progestin hormone into the bloodstream. The excess progestin would counteract the effects of estrogen in the blood stream, thereby reducing excessive menstrual bleeding and cramps.
Called as Implanon, the device effectively helps to curb menorrhagia for a period of 3 years. Like the hormonal intrauterine device, the hormonal implant would also prevent pregnancy and is only recommended in cases where the patient does not want to get pregnant for the next 6 months.
Surgical Options of the Treatment of Menorrhagia
Surgery is usually opted for in cases where the patient does not respond well to the other treatments. Surgery would also be considered as the best option in case the bleeding is caused by a serious medical condition.
For instance, if a woman experiences severe menstrual bleeding due to the presence of polyps or fibroids in her uterus, the best form of treatment for the condition would involve cutting off the blood supply to these growths (by a procedure called ‘uterine artery embolization’) or removing them completely (by a procedure called ‘myomectomy’).
Endometrial ablation is usually chosen in cases where a thickened endometrial lining is the cause for menorrhagia. The surgical procedure would involve destroying or removing all or a part of the endometrial lining. The procedure effectively reduces heavy menstrual bleeding and does not hinder pregnancy or childbirth.
Hysterectomy is usually chosen in severe cases where the condition does not respond to any of the above mentioned treatments. A hysterectomy would involve removing the uterus completely, a procedure that can permanently affect pregnancy (a woman would not be able to get pregnant after a hysterectomy).
A hysterectomy would also be the right choice for women suffering from severe conditions like endometrial cancer. The recovery period is usually a few weeks with the occurrence of mild complications now and then.
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