Published on Jun 07, 2018 and last reviewed on Sep 07, 2018 - 5 min read
In this article, I am explaining the causes, types, and investigations to diagnose menorrhagia, dysmenorrhea, irregular, unscheduled bleeding and its treatment.
Menstrual bleeding affects the quality of a woman’s life and has an impact on her physically, emotionally, and socially, with or without mild to severe signs and symptoms and it needs attention. Mostly longer, anovulatory cycles have been observed at and after puberty, whereas frequent and short interval cycles are seen in elderly women.
This is the cause of around 20 % gynecologist referrals to hospitals where one in 20 ladies of reproductive age consults a GP with heavy bleeding. 20 % of ladies have a hysterectomy (removal of the uterus) before 60 years of age due to heavy bleeding.
If periods are unacceptably heavy with or without symptoms, that is, there may or may not be clotting and flooding (not necessarily only greater than 80 ml per cycle), then they need investigations and treatment to prevent further complications like anemia, endometrial hyperplasia, and endometrial cancer.
Causes of Heavy Bleeding
1. Dysfunctional uterine bleeding (DUB)
This is without any uterine/pelvic pathology, an absence of pregnancy, or any medical or systemic disease.
It is a diagnosis of exclusion. Most women with heavy bleeding are classified as DUB. A woman of reproductive age can be treated easily even with superficial investigations and history.
DUB is abnormal bleeding due to the abnormal ratio of prostaglandin and inflammatory mediators causing excessive fibrinolysis, defective local factors, and defect in the endomyometrial junctional zone.
2. Local pathology
Heavy prolonged cycles with or without clots could be due to some local pathology like submucous fibroid (can increase blood loss to 200 ml per cycle), adenomyosis, cervical pathology present or treated, pelvic infection, endometrial or uterine polyp, endometrial hyperplasia, etc.
3. Unscheduled bleeding with use of oral contraceptive pills or after taking or skipping hormones
This bleeding/spotting actually causes a lot of stress as medications used for heavy bleeding themselves cause spotting and unscheduled bleeding as a side effect.
4. Medical disorders
Endocrine problems, thyroid abnormalities (hypothyroidism), bleeding disorders (Von Willebrand), thrombocytopenia, coagulation disorders, Cushing syndrome.
Pain during menses (dysmenorrhea) is unacceptably painful menses, mainly in the first two days of bleeding.
1. Idiopathic: mostly in teenage girls, mostly in ovulatory cycles. It might be due to oversensitivity to prostaglandins and overproduction of inflammatory mediators, their local side effects, genetic, psychological causes or neuropathic dysregulation.
2. Secondary: due to underlying cause or pathology. Could be fibroids, intrauterine contraceptive devices, cervical or uterine pathology, pelvic inflammatory disease, previous surgery (with or without postoperative adhesion), endometriosis, adenomyosis, congenital abnormalities of the pelvis, Asherman syndrome, etc.
For management of any of the above-mentioned conditions, the patient‘s wish and convenience are the most important factor.
Medical treatments for heavy, irregular/unscheduled bleeding:
Surgical treatments for heavy unscheduled bleeding
If the patient does not respond to medical treatment, surgical treatment options are advised to her.
In short, heavy, irregular, unscheduled painful vaginal bleeding needs to be investigated and treated according to patient‘s need, wish, and convenience to improve the quality of life and to prevent long-term consequences like endometrial cancer.
For more information consult a menstrual disorders specialist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist/menstrual-disorders
Query: Hello doctor, My wife is suffering from menstrual cycle problem. She is bleeding too much and her period continues for 7 days. Due to this, low BP, headache and lower back problem has started. Since last two years she is feeling weak and less energetic. Kindly suggest good medicines preferably ge... Read Full »
Answer: Hi, Welcome to icliniq.com. From the details given in your query, it seems that your wife is suffering from abnormal uterine bleeding (AUB). There are several reasons for AUB. For diagnosis, you better do one ultrasonography of abdomen and serum for thyroid function test. Meanwhile, you can try ... Read Full »
Query: Hello Doctor, I am an 18 year old female. I had my normal period last week and it lasted for 7 days. Then three days after this it started again and was really heavy.This happens almost every month. Is something wrong with my uterus? Read Full »
Answer: Hi, Welcome to icliniq.com. There can be so many reasons for irregular heavy bleeding. It can be a part of Abnormal Uterine Bleeding which has to be found out. You need to get routine blood investigations including thyroid profile and a basic pelvic scan done. Also take regular iron to correc... Read Full »
Query: Hello doctor, I am 21 years old. I decided to contact you because I do not know what to do. I had sex with my husband, and then we found out that he had a chlamydia infection. Since then, I am feeling sick all the time. My stomach was hurting a lot, and I had problems with passing urine, and it sta... Read Full »
Answer: Hello, Welcome to icliniq.com. If pregnancy is the concern, then the best way to find out is to get a blood serum beta hCG test done. This is a confirmatory test for pregnancy as the urine pregnancy kits may show false positive results. If the level of hCG is more than 1 or raised, then pregnancy ... Read Full »
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