Menorrhagia: Expert Share Tips To Manage Heavy Menstrual Bleeding

Heavy menstrual bleeding is a common problem which affects girls and women across all ages. It causes a lot of weakness, discomfort, inconvenience and often inability to perform their daily work.

The normal period flow should be for about 3 to 5 days with change of about 3 pads per day. The periods should normally come every 25 to 35 days. Any menstrual bleeding which is heavier or out of this 25 - 35 days range, should be considered abnormal and the woman should seek help from her gynaecologist.

Common reasons for heavy menses can be hormonal imbalance, bleeding disorders, fibroids, adenomyosis or endometriosis, polyps in womb, thickening or excess growth of the lining of the womb (endometrial hyperplasia) or even cancers in some patients.

The important thing is to first diagnose the reason behind heavy bleeding and this can be done by a pelvic sonography and some blood tests including hemoglobin to see if the heavy bleeding is causing anemia. Also, hormone tests for PCOS, cancer screening tests such as PAP smear etc. can be done. Most of these tests are simple and not very expensive. Sometimes, especially in older women, biopsy of the uterus lining (endometrium) or mouth of the womb (cervix) may be necessary to rule out cancer.

Treatment will depend on the cause of the heavy bleeding and may be something as simple as oral tablets for 3 - 5 days during the menses or hormone tablets throughout the month for a few months. If the woman does not want to plan a pregnancy, one of the best treatments is a hormone intrauterine device which can be placed inside the uterus in just five minutes, which then slowly releases hormones locally, reduces menstrual bleeding and gives relief from heavy menses for five years. Even injections can be given once a month to stop periods temporarily in some cases.

Polyps which are soft grape like growths inside the womb, or submucous fibroids which are simple firm tumors on the inner side of the womb cause heavy bleeding, and can be easily removed without any cuts or stitches by putting a thin telescope with a camera (hysteroscope) through the natural passage into the womb. Patient recovers quickly and can go home the same day after the procedure.

If there is a problem that requires surgery, then nowadays almost all procedures can be done by keyhole or endoscopic surgery.

Fibroids or simple tumors of the womb can be removed by laparoscopic surgery, as can be cysts of the ovary such as endometriotic cysts (chocolate cyst of ovary, where blood accumulates in the ovary). In older women even the womb can be removed if necessary, by keyhole surgery. The patient recovers fast with minimal discomfort.

There is also non-surgical treatment using MRI, which can be used to treat fibroids without any cuts or stitches.

It is important to not delay seeing your gynaecologist if you suffer from heavy menses. Many simple treatments are available to relieve you of your problem and there is absolutely no reason to suffer the discomfort of heavy menstrual bleeding.

(Dr Rishma Dhillon Pai, Consultant Gyanecologist: Lilavati, Jaslok and Hinduja Healthcare Hospitals, Mumbai, Past President: Federation of Obstetrics and Gynaecological Societies of India, Mumbai Obstetrics and Gynaecological Society, Indian Society for Assisted Reproduction and Indian Association of Gynaecologial Endoscopists)

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