Heavy menstrual bleeding

Posted by Dr. Yahya MS on December 25, 2019

According to International Federation of obstetricians and gynaecologists(FIGO),
Heavy enstrual bleeding (HMB) is defined as excessive menstrual blood loss (over several consecutive cycles) that has a major effect on a woman’s quality of life.

It affects one in three women of reproductive age, and is one of the common causes of removal of uterus in women.

What are the symptoms of heavy menstrual bleeding

Any of the following symptoms is considered heavy menstrual bleeding
o  Bleeding that lasts more than 7days
o  Bleeding that soaks through one or more pads every hour for several hours in a row
o  Needing to wear more than one pad at a time to control menstrual flow
o  Needing to change pads during the night
o  Menstrual flow with blood clots larger than 1 inch
o  Features of anaemia including tiredness, easy fatigability, difficulty in breathing, dizziness.

What are the causes of heavy menstrual bleeding?

Causes of heavy menstrual bleeding are classified based on the FIGO classification and include:

Having abnormal tissue in the uterus which can be
o  Polyps: a grape like growth in the uterine cavity
o  Fibroid: abnormal growth within the uterus commonly in the uterine muscles
o  Adenomyosis: the uterine lining grows into the muscle
o  Over growth of the uterine lining called endometrial hyperplasia and cancer of the uterine lining which can result from such over growth.

Not ovulating once per month this can be seen in the extreme of reproductive ages such as during puberty and around menopause, other common cause of not ovulating is polycystic ovarian syndrome (a condition characterised by acne, male pattern hair baldness, and abnormal hair growth, with multiple cyst in the ovaries).

Having a bleeding tendency.

Infection such as pelvic inflammatory disease.

Some form of birth control implants or pills can cause abnormal heavy menstrual bleedin.

Medications that causes thining of blood such as aspirin, heparin etc.

What are the treatment option for patient with HMB?

This will depend on what is causing the excessive bleeding, the woman’s wishes and whether you want to deliver or not. Options include:
o  Anti-inflammatory drugs such as mefenamic acid, reduces blood loss by about 25% and has the advantage of reducing pain during menses
o  Antifibrinolytic such as Tranexamic acid reduces blood loss by about half
o  Hormonal therapy using combined oral pills, progestogens, or intrauterine systems
o  Surgical options including removing the uterus for patient that completed her family, or removal of the fibroid, or polyps.
o  Rarely the lining of the uterus can be destroyed (endometrial ablation).