Heavy Menstrual Bleeding: What We Need To Know

August 1, 2022

Menstruation is the monthly shedding of the lining of a woman’s uterus. A menstrual cycle is believed to begin on the 1st day of the period.

Normal menstrual cycleoccurs at a

• Frequency of once every 24-35 days measured from 1st day of one period to the 1 st day of the next.
• Duration ranging from 2-7 days.
• Total amount of blood loss over the course of the period is around 2-3 tablespoons, not more than 80ml.

Heavy menstrual bleeding or menorrhagia is considered if bleeding is either excess in amount or of increased number of days even if the amount is less. HMB can cause a great deal of distress and discomfort for the woman. In its worst forms can even affect the normal social and sexual life of the lady.

How do you know bleeding is heavy?

Any of the following can be a sign of heavy menstrual bleeding:

• Bleeding that lasts more than 7 days.
• Bleeding that soaks through one or more tampons or pads every hour continuously.
• Requiring to wear more than one pad at a time to control menstrual flow.
• Requiring to change pads or tampons during the night.
• Menstrual flow with blood clots that are as big as a coin or larger.
• Menstrual flow that keeps you from performing your day-to-day activities.
• Are tired, lack energy, or breathless.

What are the causes of HMB?

1. Uterine problems including fibroids(non cancerous growth in the uterus),polyps (small benign growths from the lining of the uterus)or adenomyosis(symmetrical enlargement of the uterus).
2. Hormonal imbalances which may include anovulation due to PCOS,thyroid problems,obesity
3. Bleeding disorders
4. Medications like birth control pills,intrauterine devices or use of blood thinners
5. Cancers of the uterus or cervix
6. Other causes like liver or kidney disease may be associated with heavy menstrual bleeding.

What are the tests advised in case of heavy menstrual bleeding?

When you visit the gynaecologist for heavy menstrual bleeding, a detailed history is taken,followed by a physical examination which might include an internal/pelvic examination too. Frequently asked tests, based on the age of the patient and symptoms could include

• Blood tests to look for anemia, thyroid problems and other bleeding conditions or hormonal imbalances.
• Ultrasound
• Pap smear test to detect pre-cancerous lesions of the uterine cervix.
• Endometrial biopsy either in the form of pipelle sampling which is done in the OPD or some may even require hysteroscopy followed by endometrial biopsy.
In this procedure a sample of the endometrium, which is the lining of the uterus, is taken and sent to the lab for examination under the microscope.

It is a good practice to maintain a menstrual calendar, which helps to track the frequency and duration of one’s menstrual cycle.

What are the treatment options available?

Treatment options depend on

• Overall health and medical history
• Cause and severity of the condition
• Age of patient and likelihood that periods may become less heavy soon.
• Future childbearing plans
• Personal preference.
• Results obtained from the tests done.

Treatment options include

1. Medical treatment which may be hormonal or non-hormonal.
2. Insertion of a hormone secreting intra uterine device.
3. Surgical treatment which may be dilation and curettage, uterine artery embolization, endometrial ablation or hysterectomy.
4. Treatment of the cause.

The treatment for each patient is tailored on a case-to-case basis. Some respond to the medical management while some might require a surgical intervention. It is best to discuss all treatment options with your gynaecologist for maximum benefit.

What are the complications if left untreated?

Heavy menstrual bleeding may be a sign of an underlying health problem that needs treatment. Blood loss from heavy periods also can lead to a condition called iron-deficiency anemia. Severe anemia can cause shortness of breath and increase the risk of heart problems.



By Dr Shannon Fernandes
Dr Shannon Fernandes is a Consultant Obstetrician and Gynaecologist at Father Muller Medical College . She is also available for consultation at Parin Building, Balmatta.
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Comment on this article

  • Sr Susheela Monteiro, Shanthidham,Deralakatte

    Wed, Aug 03 2022

    Thank you Dr Shannon for the informative article it will be useful to many.

  • Rita, Germany

    Mon, Aug 01 2022

    This is a thema urgently read by young girls and women.Many women dont know or feel shy to ask someone about this. .Thinking it is normal so with women .I too thought this in the beginning till I knew what is the matter.My mother too had this.She never gone to doctor or that time not had the chance to consult it.Until she was so sick and had to undergo Hysterectomy.Good you brought out this and hope many girls/women make use of this instead of suffering unnecessarily.THank you.

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