Expert Advice on Heavy Menstrual Bleeding Management

Dr. Talat Uppal is the Director at Women’s Health Road, an innovative multidisciplinary medical centre for women located in Frenchs Forest, Sydney. She is an esteemed Obstetrician and Gynaecologist, currently serving at both the Northern Beaches and Hornsby Ku-ring-gai Hospitals.

Additionally, Dr. Uppal is a Clinical Senior Lecturer in Obstetrics and Gynaecology at Macquarie University.

With over a decade of experience, Dr. Uppal previously held the role of Senior Obstetrics Staff Specialist and Clinical Director of Women’s, Children & Family Health at Manly and Mona Vale Hospitals. She has also chaired the NSW State Reference Committee and the NSW RANZCOG Education Subcommittee.

As a RANZCOG Media Spokesperson, Dr. Uppal is a vocal advocate for women’s health. Her special interest lies in supporting the role of General Practitioners within the women’s health context.

Heavy menstrual bleeding (HMB), also known as menorrhagia, is a common but often misunderstood condition. It affects many women at some point in their lives, significantly impacting their daily activities and overall quality of life. This comprehensive article will delve into the symptoms, causes, and treatment options for heavy menstrual bleeding, providing valuable insights for those experiencing this condition.

What is Heavy Menstrual Bleeding?

Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman’s physical, emotional, social, and material quality of life. Clinically, it is often characterized by:

• Menstrual periods lasting more than 7 days.
• Needing to change sanitary protection every 1-2 hours.
• Passing large blood clots.
• Symptoms of anemia, such as fatigue or shortness of breath.

Symptoms of Heavy Menstrual Bleeding

Recognizing the symptoms of heavy menstrual bleeding is crucial for seeking appropriate treatment. Common symptoms include:

1. Prolonged Bleeding: Menstrual periods that last more than a week.
2. Excessive Blood Loss: Soaking through one or more sanitary pads or tampons every hour for several consecutive hours.
3. Passing Large Clots: Blood clots larger than a quarter during menstruation.
4. Interference with Daily Activities: The need to double up on sanitary protection to control menstrual flow or to change sanitary products frequently, even at night.
5. Symptoms of Anemia: Fatigue, shortness of breath, and pallor, due to significant blood loss.

Causes of Heavy Menstrual Bleeding

Several factors can contribute to heavy menstrual bleeding. Understanding these causes can help in diagnosing and managing the condition effectively. Some of the common causes include:

1. Hormonal Imbalances: Hormonal imbalances, especially involving estrogen and progesterone, can lead to heavy menstrual bleeding. These hormones regulate the buildup of the endometrial lining, which is shed during menstruation. An imbalance can result in a thicker endometrial lining, causing heavier periods.
2. Uterine Fibroids: Fibroids are non-cancerous growths in the uterus that can cause heavy menstrual bleeding, prolonged periods, and pelvic pain. They are common in women of reproductive age and can vary in size from tiny seedlings to large masses that distort and enlarge the uterus.
3. Polyps: Uterine polyps are small, benign growths on the lining of the uterus (endometrium) that can cause heavy or prolonged menstrual bleeding.
4. Adenomyosis: Adenomyosis occurs when the endometrial tissue, which normally lines the uterus, begins to grow into the muscular wall of the uterus. This can lead to heavy menstrual bleeding and severe menstrual cramps.
5. Blood Clotting Disorders: Conditions such as von Willebrand disease and other bleeding disorders can cause heavy menstrual bleeding. These conditions affect the blood’s ability to clot properly, leading to excessive blood loss during menstruation.
6. Intrauterine Device (IUD): While IUDs are a popular form of long-term contraception, some types, particularly the non-hormonal copper IUD, can cause increased menstrual bleeding and cramping.
7. Medications: Certain medications, including anticoagulants and anti-inflammatory drugs, can contribute to heavy menstrual bleeding by affecting the blood’s ability to clot.
8. Cancer: Though rare, cancers of the uterus, cervix, or ovaries can cause abnormal menstrual bleeding, including heavy periods.

Diagnosing Heavy Menstrual Bleeding

If you suspect you have heavy menstrual bleeding, it is essential to seek medical advice. A healthcare provider will conduct a thorough evaluation to determine the cause and appropriate treatment. Diagnostic methods may include:

1. Medical History and Physical Examination: Your doctor will take a detailed medical history and perform a pelvic exam to check for abnormalities.
2. Blood Tests: These can help identify anemia and check for thyroid problems or blood clotting disorders.
3. Pap Test: This test can detect changes in the cells of your cervix, which may indicate cervical cancer.
4. Endometrial Biopsy: A small sample of the endometrial tissue is taken to check for abnormalities.
5. Ultrasound: This imaging test uses sound waves to create a picture of your uterus, ovaries, and pelvis.
6. Hysteroscopy: A procedure that involves inserting a thin, lighted instrument into the uterus to examine the lining.

When to See a Doctor

It is essential to consult a healthcare provider if you experience any of the following:

• Menstrual periods lasting more than 7 days.
• Soaking through one or more sanitary pads or tampons every hour.
• Passing large blood clots.
• Symptoms of anemia, such as fatigue or shortness of breath.
• Severe menstrual cramps or pelvic pain.
• Menstrual bleeding that interferes with daily activities.

Living with Heavy Menstrual Bleeding

Living with heavy menstrual bleeding can be challenging, but several strategies can help manage the condition and improve your quality of life:

• Track Your Menstrual Cycle: Keeping a menstrual diary can help you and your healthcare provider identify patterns and assess the effectiveness of treatments.
• Plan Ahead: Carry extra sanitary protection and a change of clothes during your menstrual period.
• Stay Hydrated: Drink plenty of fluids to prevent dehydration, especially if you experience heavy blood loss.
• Manage Stress: Practice stress-relief techniques such as yoga, meditation, or deep-breathing exercises.

Conclusion

Heavy menstrual bleeding is a common condition that can significantly impact a woman’s quality of life. Understanding the symptoms, causes, and treatment options is crucial for managing the condition effectively. If you experience heavy menstrual bleeding, consult a healthcare provider for a thorough evaluation and personalized treatment plan. With the right approach, you can manage heavy menstrual bleeding and maintain a healthy, active lifestyle.

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