Heavy Menstrual Bleeding – Causes and Treatments

Heavy menstrual Bleeding also known as menorrhagia is soaking a pad or tampon every hour or less during each menstrual cycle.  Heavy period is a huge problem to some women affecting their daily lifestyles in their time of the month.

Heavy bleeding does not mean there is an underlying condition, but it can affect physically and emotionally causing distraction during the period. Heavy period varies from woman to woman; the average amount of blood lost during a period is 30-40 millilitres (ml), with 9 out of 10 women losing less than 80ml. Heavy menstrual bleeding is considered to be 60ml or more in each cycle.  However, it is not necessary to measure blood loss, some women have a idea about how much bleeding is normal for them during their period and would know if the blood amount increases or decreases.

The heavy menstrual bleeding can lead to iron-deficient anaemia; the most common health-related threat of menorrhagia causing symptoms such as shortness of breath, severe fatigue and heart palpitation, which can require urgent medical attention. Most cases of anaemia are easily treated with oral iron supplements and healthy foods.

Causes of Heavy Menstrual Bleeding (Menorrhagia)

There are many causes of heavy bleeding, they include:

• Hormonal imbalance: In hormone imbalance, the endometrium (lining of the uterus) develops in excess resulting to heavy menstrual bleeding.
• Uterine fibroids: These noncancerous tumours of the uterus, which appear during childbearing years.
• Polycystic ovary syndrome (PCOS): PCOS is a common condition that affects how the ovaries work; it causes irregular and heavy period.  
• Pelvic inflammatory disease (PID): an infection of the uterus, fallopian tubes and other reproductive organs, which can cause pelvic, abdominal pain and menstrual bleeding.
• Intrauterine device (IUD): This can cause heavy period for the first three to six months after insertion.  When an IUD is causing excessive bleeding, speak to you doctor.
• Polyps: cervical or endometrial polyps – non-cancerous growths in the lining of the womb or cervix (neck of the womb) may cause prolonged menstrual bleeding.
• Cancer: This is uncommon, uterine cancer; ovarian cancer and cervical cancer can cause excessive menstrual bleeding.
• Blood clotting disorders: Some blood coagulation disorders such as Von Willebrand disease can cause abnormal menstrual bleeding.

Treatments for Heavy Menstrual Bleeding

The treatment for Heavy Menstrual bleeding can be divided into lifestyles, medical and surgical options. Let’s look at the different options together:

Lifestyle Options

There are several lifestyle options you may want to try to reduce your heavy menstrual bleeding. These include:

• Ice packs: Put an ice pack on your abdomen for 20 minutes at a time, several times a day when bleeding is especially heavy.
• Vitamins: Try vitamin C supplements to help your body absorb iron and possibly strengthen blood vessels.
• Iron:  Some research suggests low iron levels can increase menstrual bleeding, and that supplementing with the mineral can reduce menstrual bleeding.

Medical Options

Your specialist may recommend a medical treatment first for the menstrual bleeding. Here are some treatment options that your healthcare professional might discuss with you, depending on your health history.

• Nonsteroidal anti-inflammatory drugs. These drugs include naproxen (Aleve), ibuprofen (Motrin), and mefenamic acid work by reducing levels of prostaglandins, hormone-like substances. NSAIDs can also help to reduce period pain.
• Oral contraceptive pill: Oral contraceptives can be used to treat heavy periods. It contains the hormones oestrogen and progestogen and the combination estrogen-progesterone pill Natazia is the first birth control pill specifically approved by the FDA to treat heavy menstrual bleeding not caused by a condition of the uterus.  Taking one pill every day for 21 days before stopping for seven day you get your period.
• Progestin. Progestin is the most-prescribed medication for menorrhagia, with studies finding that it can reduce bleeding up to 15 percent.  Progestins work by reducing the effects of estrogen in your body, slowing growth of the uterine lining. Common side effects of Progestin include weight gain, headaches, swelling and depression, many women stop using this option because of the side effect.
• Gonadotropin-releasing hormone analogue (GnRH agonists) is a hormone drugs sometimes given as an injection to treat fibroid. Studies have shown that GnRH-a is effective in reducing blood loss during period by 90%. However, it can only be used on a short-term basis because of their high cost and may also cause hormone abnormalities, send a woman into menopause, hot flashes, increased sweating, vaginal dryness and long-term use could lead to osteoporosis. GnRH-a is not a routine treatment but may be used while awaiting surgery.
• Intrauterine device (IUD): The FDA has approved the levonorgestrel intrauterine system (Mirena) to treat heavy menstrual bleeding in women who use intrauterine contraception as their method of birth control prevention. It is recommended for women who have already had a child. This is a new indication for Mirena, which was approved by the FDA in 2000 as a contraceptive.

Surgical Options

• Hysterectomy:  Is a surgical procedure to remove the womb. Seventy-five to 80 percent of women with heavy menstrual bleeding do not need a hysterectomy, yet many women still opt for this surgical procedure, which is frequently recommended as a treatment option. While very effective in ending uterine bleeding (without a uterus, your periods stop), Ask your health care professional to fully explain the surgery and potential benefits and risks to you. Other, non-surgical option is:
• Endometrial ablation: This is a minor procedure that just involves removing the lining of the uterus via freezing, electricity, microwaves, radio frequency (radio waves) or hot water. Ablation is performed on an outpatient basis or in a doctor's office with mild anaesthetic and has a very quick recovery; it is mainly used to reduce heavy bleeding in women without fibroid.
• Myomectomy: (In the case of fibroid) is a surgery to remove a fibroid from the wall of your womb, it may be considered, as an alternative to a hysterectomy if you still like to have children. Your gynaecologist can tell you whether the procedure is suitable for you based on certain factors such as the size, number and position of your fibroids.

Advice

Always check with your health care professional before taking any medication, herbal remedies and nutritional supplements for managing health conditions or for general health and wellness.

Ask questions from health care professional before making any decisions on heavy menstrual bleeding treatments.

Other surgical procedures, myomectomy and uterine artery embolisation are recommended if fibroids are the cause of the bleeding. Ask for medical options.