What is Heavy Bleeding?

You usually lose the same amount of blood every month. This varies with age though. Around 80 ml blood loss every menstruation cycle is normal. Anything above it is considered heavy bleeding.

You know you have excessive menstrual bleeding if;

• You notice clotting. Normal menstrual blood never clots. The uterus produces an anti-clotting agent to ensure smooth blood flow. In case of heavy bleeding this is used up and the remaining blood may come out as clots.
• You may not experience clotting but if there is excessive flow of blood then you have heavy bleeding. i.e: You have to change pads more than three-four times a day.
• You have spotting for 15 days in a cycle.

Heavy bleeding can occur at any age; i.e.: puberty, reproductive stage, pre-menopausal stage and post-menopausal stage.

If you have been bleeding heavily and your period extends over seven days, you must consult a gynaecologist.

Reasons for Heavy Bleeding

Pelvic Disorders

• Fibroids are one of the most common reasons for heavy bleeding. These are a benign growth in the uterus made up of muscle fibre.
• Polyps is an abnormal growth of tissue from a mucous membrane. These cause irregular spotting more than heavy bleeding.
• Endometrial cancer affects the lining of the uterus. It is more common after menopause.
• Endometriosis, a condition wherein the lining of the uterus grows outside the uterus.

Hormonal Disorders

• Anovulatory bleeding, which occurs when you don't ovulate.
• Thyroid wherein a dysfunctional thyroid gland can lead to heavy bleeding.

Use of Intra Uterine Devices (IUD) such as Copper T for contraception can also lead to heavier periods.

Stress, obesity, anaemia and the onset of menopause are also known to cause heavy bleeding.

How is it Treated?

The type of treatment prescribed will depend on your age and whether or not you have had a child.

If you are in the reproductive stage and want to have more children, then doctors usually prescribe drugs.

• Besides birth control, contraceptive pills reduce bleeding.
• Drugs like aspirin and mefenemic acid are often recommended. They also help alleviate menstrual pain and cramps. This option may cause headaches and dizziness though.
• If anaemia is the reason for heavy bleeding, doctors prescribe iron and vitamin C supplements. Besides this, you need to eat a lot of leafy green vegetables, meat, fish and dried fruits.

If you are over 40 years and nearing menopause, a hysteroscopy may be recommended. This is a visual examination of the uterus and the uterine lining. It will help doctors detect if there are fibroids or polyps in the uterus. The whole process takes about 10 minutes. If polyps or fibroids are detected, then an operational hysteroscopy is performed.

D&C (Dilatation and Curettage) is rarely used to treat heavy bleeding. The lining of the uterus is then scraped away. D&C is used mainly to screen for endometrial cancer.

The drawback is that it is an invasive procedure and can lead to a weakening of the cervix. Also, a D&C can miss out polyps.

Another way to treat heavy bleeding is through thermal balloon therapy. Here, a hot balloon filled with water is used to remove the uterine lining. Though expensive, the procedure has a 96% success rate. This is a good option if you are in your pre-menopausal stage.

In extreme cases, a hysterectomy is advised. Here, the uterus is removed and heavy bleeding is stopped permanently. Hysterectomy is performed if you have cancer of the lining of the uterus. It is not advisable if you want to have more kids.

If thyroid is causing heavy bleeding or you have anovulatory bleeding, you will be put on a hormone replacement therapy.

(With inputs from Gynaecologist: Dr. Ranjana Dhanu, Lilavati Hospital)