Heavy Menstrual Bleeding

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Heavy Menstrual Bleeding

Menorrhagia -Heavy menstrual bleeding (HMB), also known as menorrhagia or hypermenorrhea, means excessive heavy menstrual flow. HMB is when a woman experiences excessive vaginal bleeding of  more than 80 ml of blood loss

In this condition, periods can prolong for 7 or more days with extreme bleeding and there may also be a large clot formation 

Puberty Menorrhagia

Puberty menorrhagia is defined as excessive bleeding in amount (>80 ml) or duration (>7 days) between menarche and 19 years of age.

Menarche is a hallmark event in the life of most adolescent girls. It marks the transition from childhood to puberty

  1. The most common cause of Heavy Menstrual Bleeding (HMB) in adolescents is anovulatory cycles
  2. Mild bleeding with normal haemoglobin can be managed with reassurance, non-hormonal treatments and observation
  3. Hormonal therapy aims to stabilise the endometrium.                                             Other causes of Menorrhagia– include:
  • Hormonal imbalance. In a normal menstrual cycle, a balance between the hormones estrogen and progesterone regulates the buildup of the lining of the uterus (endometrium), which is shed during menstruation. If a hormonal imbalance occurs, the endometrium develops in excess and eventually sheds through heavy menstrual bleeding.
    Several conditions can cause hormone imbalances, including polycystic ovary syndrome (PCOS), obesity, insulin resistance and thyroid problems.
  • Uterine fibroids. These noncancerous (benign) tumours of the uterus appear during reproductive years. Uterine fibroids may cause heavier than normal or prolonged menstrual bleeding.
  • Polyps. Small, benign growths on the lining of the uterus (uterine polyps) may cause heavy or prolonged menstrual bleeding.
  • Adenomyosis. This condition occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding and painful periods.
  • Intrauterine device (IUD). Menorrhagia is a well-known side effect of using a nonhormonal intrauterine device for birth control. .
  • Cancer. Uterine cancer and cervical cancer can cause excessive menstrual bleeding
  • Inherited bleeding disorders. Some bleeding disorders — such as von Willebrand’s disease, a condition in which an important blood-clotting factor is deficient or impaired — can cause abnormal menstrual bleeding.
  • Medications. Certain medications, including anti-inflammatory drugs, hormonal medications such as estrogen and progestins, and anticoagulants such as warfarin or enoxaparin can contribute to heavy or prolonged menstrual bleeding.
  • Other medical conditions. A number of other medical conditions, including liver or kidney disease, may be associated with menorrhagia.

Medications used to treat heavy menstrual bleeding

Iron supplements -improve the well-being of the patient 

NSAID – can ease cramps and reduce bleeding.

  • Birth control pills and other Hormonal treatments can help balance the amount of estrogen and progesterone in the body so that the menstrual flow isn’t as heavy. HT is often recommended for heavy menstrual bleeding.
  • Antifibrinolytic medicines, like tranexamic acid, prevent clots from breaking down and prevents excessive bleeding.

Procedures used to treat heavy-period bleeding

Hysteroscopy is often used to diagnose and treat heavy-period bleeding.  Hysteroscope is a precise surgical instrument. It is a procedure by which a Hysteroscope is inserted inside the uterine cavity which allows inspection as well as operative intervention inside the uterine cavity

Other procedures include:

  • Laparoscopic Myomectomy. – A procedure that removes fibroids from the uterus.
  • Uterine artery embolisation A procedure that restricts the blood flow from fibroids and tumours.
  • Endometrial ablation -A procedure that destroys all or part of the lining of the uterus. 
  • Total laparoscopic Hysterectomy – Surgery that removes uterus                  Conclusion

Treatments to reduce abnormally heavy bleeding depend on the underlying cause, It can include hormonal birth control, hormonal therapy, and drugs that reduce the amount of bleeding or surgical intervention 

Women with benign heavy menstrual bleeding have the choice of a number of medical and surgical treatment options to reduce their blood loss and improve their quality of life