Everything You Need To Know About – Heavy Menstrual Bleeding

Heavy Menstrual Bleeding (Menorrhagia)

Overview

Do you know, that 14% of the women in India suffer from heavy bleeding? Only 1/3rd of the women go to the hospital to get it treated. During her lifetime a woman gets periods almost 450 times.

During each period a woman loses 60 milliliters. of blood. In case of a heavy flow, it can go up to 80 milliliters. The question is how do you measure the exact quantity of blood lost?

As the best gynecologist hospital in Vadodara, when we ask patients about the quantity of blood loss they experience during the period, they are clueless. At most what people answer is that “I need to change a sanitary napkin or a tampon after a gap of every 2 hours”.
I can very well understand your dilemma. I have been working as a gynecologist in Vadodara at Janvi Multispeciality hospital for a long time now. Hence, today through this write-up, I intend to discuss ‘abnormal bleeding.
After  you read this fully, you will come to know:

  • When is bleeding considered abnormal

  • How can you measure the quantity of blood lost in bleeding


  • What causes it

  • What are its symptoms


  • What kinds of tests are carried on to detect it

  • When to approach a doctor

  • What treatments are available to treat it


Let’s dive in!

When is bleeding considered to be abnormal?

Generally, women have a menstrual cycle of 28 days. This means that after every 28th day, they are going to get periods. The bleeding continues for 3 to 5 days. Sometimes, it takes a little longer.
As a gynecologist hospital in Vadodara, people want to know our view on it. It is interesting to know that there is nothing wrong if some women have a smaller cycle (lesser than 28 days) or a bigger cycle that is greater than 28 days.
Also, the duration of bleeding differs. Some women bleed for 5 days whereas the others can have a longer duration. In general, it is seen that if your periods occur at intermittent intervals and continue for 7 days or more then they can result in abnormal bleeding.

How can you measure the quantity of blood lost in bleeding?

This is the most important question that we ask our patients. As one of the best gynecologists in Vadodara, I must guide you on this complex subject. Women use different devices during periods like sanitary napkins, tampons, menstrual cups, clothes, etc.
All companies manufacture their own set of products and we aren’t pretty certain about the absorbing capacity of the product used. In such cases, we can use two parameters to judge whether you are having a heavy flow.

  1. How many times do you need to change the pad or tampon? This gives us an idea about the quantity of bleeding that you might be having

  2. What is the exact quantity of bleeding in a day? (we can use a menstrual cup to measure it)


At this point, it is interesting to know that when you bleed, it is not just the blood. According to PubMed Central, the bleeding consists of 36% blood and 64% of certain other elements such as:

Blood clots

Tissue

Mucus

So if you want to measure the exact amount of blood loss then you need to multiply the quantity of blood that you obtain in the measuring cup by 0.36. This will give the exact quantity of blood loss.

We consider blood loss to be normal if it falls between 30 to 60 milliliters. For example, if you get the quantity of 120 milliliters, you need to multiply it by 0.36. After doing it, you get 43.2 milliliters. This falls within the range of ‘normal bleeding’.

There is no need to worry even if you have heavy bleeding unless:

It makes you faint

It makes you feel weak

You bleed for more than seven days

You need to change your tampon within a short period

You need to change a tampon even at night

You experience anemia or shortness of breath

You pass heavy blood clots during the mensuration cycle

Only in the above cases do you need to take care, else just by paying attention to diet before and after the periods, you can increase your hemoglobin levels. Foods like beetroot, green leafy vegetables, spinach, peas, beans, legumes, seafood, seeds & nuts, and dry fruits are rich sources of hemoglobin.

Causes and Symptoms

What causes heavy bleeding?

Treating heavy bleeding is a different thing. What we try to do as a gynecologist hospital in Vadodara, is to go to the root cause which is causing heavy bleeding. After analyzing the proper cause, we can look for the options to treat it.

Here are some of the causes that cause heavy bleeding.

Intrauterine device (IUD)

An IUD is a device used for contraception. It is implanted in your body through a minor surgical procedure. As a gynecologist in Vadodara, I’ve observed quite a few cases where women experience heavy bleeding associated with cramping, back pain, and irregularity in periods. But all of these problems subside after some time.

Polycystic ovarian syndrome (PCOS)

PCOS is a big topic in itself. As a gynecologist hospital in Vadodara, we feel that people are quite unaware of this problem and seldom approach hospitals for it. PCOS is related to hormonal imbalance. It directly affects the functioning of ovaries and causes weight gain, unwanted hair growth on various parts of the body, and irregular and heavy periods.

Endometriosis

Endometriosis is a painful disorder in which the tissue grows outside the uterus. It involves your ovaries, fallopian tubes, and the tissues lining the pelvis. Endometriosis is also one of the causes of heavy bleeding and can cause pain during periods.

Pelvic inflammatory disease (PID)

Pelvic Inflammatory Disease causes infection in the uterus, ovaries, and fallopian tubes. As the best gynecologist in Vadodara, I often find this to be one and PCOS to be one of the prime causes of heavy bleeding.
If you are observing severe pain during urination, abdominal pain, irregular periods, or heavy bleeding then consult you need to consult a gynecologist at the earliest.

 

Fibroids

You must have heard about fibroids and polyps lots of times. These are non-cancerous tumors that develop into the muscles of the uterus.

Polyps

Polyps are similar to fibroids. They develop in the lining of the uterus or cervix. Polyps restrict the uterine muscles from contracting. If the muscles are unable to contract properly then proper shedding does not occur during the periods and this leads to heavy bleeding.

Adenomyosis

Adenomyosis is a disorder in which the uterine tissue is embedded in the uterine walls. This prevents the tissue from flowing out with the menstrual flow. Often, this can be a reason for heavy bleeding.

Hypothyroidism

Hypothyroidism occurs when the thyroid is underactive. Underactive thyroid leads to hormonal disturbances. Hormonal disturbances can cause heavy bleeding and unexplained weight gain.

Bleeding disorders

Sometimes bleeding disorders can also lead to heavy mensuration. It is advisable not to take any medicine without your doctor’s advice as it can adversely affect your health.

Certain medications

Anticoagulant medications and chemotherapy medications prevent blood clots and can interfere with your mensuration.

Hormone imbalance

Two hormones, estrogen, and progesterone regulate the built-up of the lining of the uterus. The lining of the uterus known as the endometrium is shed during mensuration. If excess endometrium is built up due to hormonal imbalance then it is cleared during mensuration and results in heavy bleeding.

Miscarriage

Miscarriage can lead to an unusual location of the placenta and result in heavy bleeding.

Cancer

Uterine cancer or cervical cancer can cause heavy menstrual bleeding.

What are the symptoms of heavy bleeding?

If you think that you are having heavy bleeding then you should consider measuring the exact quantity. If you can’t measure it then here are some pointers that you should consider regarding the below symptoms.

If you need to change tampons or sanitary pads every hour

If you require to use more than one sanitary product at a time.

If you require changing pads even at night.

Excessive fatigue, pelvic pain, abdominal pain.

Shortness of breath.

Inability the o perform the regular activity.

Diagnostic Tests

What kinds of tests are carried on to detect heavy bleeding?

Blood Test:

A simple blood test can reveal your hemoglobin levels, thyroid, or other blood-clotting issues.

Pap Test:

In the Pap test, cells are collected from the cervix and checked for infection. It is especially important to check whether they are cancerous.

Endometrial biopsy:

An endometrial biopsy consists of taking samples from the uterus. They are later evaluated by a pathologist to judge the cause of high bleeding.

Ultrasound:

Ultrasound produces sound waves and produces images of the uterus and other organs. As a gynecologist in Vadodara, we observe these movements on the screen and can get an idea of where things are going wrong.

Sonohysterography

This test is done provided we need some additional tests. During this test, fluid is injected into the uterus and then through ultrasound, we try to look into your uterus to have a more clear picture.

Hysteroscopy

Hysteroscopy involves an examination of the uterus in detail. This is done by inserting a small tube through the vagina.

Dilation and curettage (D&C)

This procedure is done under anesthesia. It involves scraping and then examining the uterine cavity.

Risk Factors

When is heavy menstrual bleeding considered a medical emergency according to gynecologists in Vadodara?

See your gynecologist doctor immediately if you:

You need to change your sanitary pad or tampon frequently in one hour

Bleeding does not stop in seven days

Experience heavy blood clots

Fatigue, weakness

Inability to sleep or work due to periods

Shortness of breath

Excessive weight makes you prone to heavy bleeding

If you are having a higher number of pregnancies then you are at risk of heavy bleeding.

Smoking increases the risk of heavy periods increase the chances of heavy bleeding

Stress

Exercising too much can result in heavy bleeding

Treatments

What treatments are available to treat it?

There are various treatments for heavy bleeding. However, as a gynecologist in Vadodara, I would suggest you opt for the treatment that suits your body.

  • Medical history
  • Female reproductive health
  • The severity of the condition
  • Presence of other co-morbidities
  • Future pregnancy plans
  • Personal preferences

Treatment for heavy bleeding can be done through medications or through performing various surgical procedures. I know you might be scared to read it but as the best gynecologist in Vadodara, I must explain it to you. We give anesthesia for surgical procedures so that is a painless procedure.

Medications

Medical therapy for controlling heavy bleeding includes:

NSAIDs

Nonsteroidal anti-inflammatory drugs help to reduce menstrual bleeding and can provide you relief from menstrual cramps. Ibuprofen and naproxen sodium are some of the medicines that you can take to reduce bleeding.

Tranexamic acid

Tranexamic acid can be consumed in the form of tablets at the time of bleeding. It helps in reducing the bleeding

Oral contraceptives

Oral contraceptives help to control the hormonal imbalance and thereby they help to reduce bleeding

Hormonal IUD (Liletta, Mirena)

It is a type of device which needs to be placed inside your women reproductive organ. Once placed inside the body, it releases a type o progestin called Levonorgestrel. Levonorgestrel helps to make the uterine lining thin and thereby reduces the blood flow during menstruation.

Iron Supplements

Heavy bleeding makes you weak and anemic. To maintain the correct level of hemoglobin, as a precautionary measure, we generally start with iron supplements.

Procedures

Uterine artery embolization

If fibroids are the reason behind your heavy bleeding and you’re of childbearing age then removing the uterus is not an ideal solution. Instead of that at our gynecologist hospital in Vadodara, we shrink the fibroids. We shrink the fibroids by blocking the uterine arteries and cutting off the blood supply to them.

The procedure is painless as we administer anesthesia. Later we pass a catheter through a large femoral artery and guide it to the uterine artery. After the blood vessel is injected with medicines that decrease the blood flow to the fibroid and stop its further growth.

Focused ultrasound surgery

This procedure is quite similar to the above but the only thing is that it is a painless procedure and instead of medicine sound waves are used to destroy the fibroids. No incisions are needed.

Balloon/Endometrial ablation

In this procedure, a special balloon filled with hot fluid is inserted into the uterus. The hot fluid in the balloon helps to thin/wipe the lining of the uterus. As a gynecologist in Vadodara, we have got many positive feedbacks from our patients regarding the helpfulness of this treatment in reducing bleeding.

Myomectomy

Myomectomy is the surgical removal of fibroids. It can be laparoscopically or hysteroscopically (through the cervix). Depending on the location, size, and several fibroids present in the uterus, we decide which process to employ.

Dilation and curettage (D&C)

In this procedure, we open (dilate) your cervix and then scrape or suctions tissue from the lining of your uterus to reduce menstrual bleeding. This process is successful most o the time however, you may need additional D&C procedures if menorrhagia/heavy bleeding is repeated.

Radiofrequency ablationpen/Endometrial resection

In this surgical procedure, we use an electrosurgical wire loop to remove the uterus lining. This is similar to one to balloon ablation.

Hysterectomy

This is the last alternative we suggest to our patients as the best gynecologist hospital in Vadodara.  Hysterectomy is the surgical removal of the uterus and cervix through open surgery or laparoscopy.

All the above procedures are done in a single day and mostly we discharge the patient in a few hours. However, in the case of myomectomy or hysterectomy, we need to do hospitalization.

Our advice to the patients who come to us is to verify the cause of heavy bleeding. If the cause is an underlying medical condition or some medicine then we recommend you to treat that particular condition to help you with bleeding issues.

Prevention

Now that you know the symptoms, causes, and cure for heavy bleeding let us turn our attention toward prevention.

Diet and supplements

Try to avoid these foods before your periods. By avoiding these foods you won’t have hot flushes during your periods.

Foods to avoid before periods:

Chilies

Milk chocolates

French fries

Pizza

Red meat

Alcohol

White rice

Coffee

White bread

Include the following in your diet after your menstrual cycle:

Dark green leafy vegetables

Whole cereals and millets

Foods rich in Vitamin C

Nuts and seeds

Bananas

Chamomile tea

Turmeric

Dates, raisins (black), and dried apricot

Medications

Certain medicines containing Tranexamic acid can help to reduce bleeding. If heavy bleeding is due to hormonal imbalance then medicines that help to balance it help.

Surgeries

Surgeries to remove the uterus can help to stop bleeding.

Complications

Anemia:

Heavy bleeding can cause anemia. It is necessary to restore it through a proper diet.

Osteoporosis:

Too much blood loss can have an effect on your bones. It is necessary to take proper dietary supplements to keep your bones healthy.

Quality of life:

If heavy bleeding is due to the following reasons then it can cause infertility.

  • Hormonal disturbances
  • Uterine periods
  • Side effects of some treatment
  • Other physical conditions

Living with

What are the complications of heavy bleeding?

CAUTION:  Abnormal/Heavy bleeding can lead you to an anemic condition. If the blood count of Haemoglobin goes below 7 then it can be life-threatening and even lead to multiple organ failures. For opinions or appointments, you can visit our website and fill in the required details. Don’t delay.

Don’t bear the pain because a delay can drive the problem in a new direction and make it uncontrollable.

Women are you listening??????

A woman is a creator. She plays different roles and she is the one who links with every relation in the family. I’ve seen many women tolerate heavy bleeding issues or postpone the treatment. It’s a humble request from me, in the capacity of the gynecologist in Vadodara not to do it. It can be scary. We are always open for consultation and queries.

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