Heavy menstrual bleeding is characterized by more blood flow than normal or blood flow that lasts for longer period of time. This type of menstrual bleeding is called menorrhagia. Many women believe that this is normal and that ultimately they have to adapt to this new way of living even though it may affect their social, personal or professional life.
Menorrhagia is a symptom that must be seriously taken into consideration because sometimes it is the result of hazardous conditions.
What is heavy bleeding?
In previous years there was a tendency to quantify bleeding from the vagina. According to this tendency 50 to 70 ml of blood during the menstruation was considered to be normal. Unfortunately this index (calculating the volume of blood that is expelled throughout the period) is difficult to be used. It is also common knowledge that between women who are completely healthy each one has different volume of blood going out every month.
In conclusion if the periods are so heavy that they affect the woman’s social, personal, professional life and generally her everyday routine, she should seek advice from a specialist so that her problem is properly investigated and treated.
When a woman believes that something has changed and she either has more bleeding during her menses or more days of continuous bleeding (in regard to her previous menstruations) this might be a sign which probably indicates that this woman has menorrhagia.
What are the causes of menorrhagia?
- Endometrial polyps:Polyps are a form of endometrial hyperplasia. Most of the times they are found inside the endometrial cavity. Sometimes they can be found inside the cervical canal and rarely they can protrude through the cervix into the vagina causing bleeding during sexual intercourse.
- Endometriosis:Endometriosis is a very common condition that affects millions of women worldwide.
- Adenomyosis:Adenomyosis is the growth of endometrial-like cells inside the muscle of the uterus and it can cause heavy bleeding, intense pain during menses and pain during sexual intercourse.
- Irregular function of thyroid gland:When the thyroid gland is not functioning normally there is a high chance that this may have an impact on a woman’s menstrual cycle.
What kind of investigations are needed?
Most of the times obtaining a detailed medical history along with a thorough clinical examination can provide us with a lot of valuable information.
Further investigations that might be needed are:
- blood tests:to check for possible anemia, coagulopathies and thyroid conditions
- transvaginal ultrasound:to investigate for possible polyps, myomas or endometrial hyperplasia.
- Hysteroscopy: this investigation belongs to the minimally invasive techniques It allows us (with the help of a fine camera) to see under direct vision and examine with detail the whole endometrial cavity. This investigation can be diagnostic and therapeutic at the same time as we can completely remove polyps or myomas of certain types that we may find during the procedure. Another advantage of hysteroscopy is that if during the procedure we feel that an area is “suspicious” we can effectively obtain a guided biopsy.
What are the treatment options?
- Non-hormonal therapies
- Mirena IUCD
- Hormonal therapies
- Endometrial ablation *
- Hysteroscopically removal of polyps/myomas (See here)
- Laparoscopic treatment (see here)
- Laparoscopic hysterectomy (see here)
*Dr Kyriakopoulos uses the advanced Novasure 2nd gen. ablation system whose success rate reaches 90%.
Heavy menstrual bleeding is a common problem but women should be aware that there are various treatments available which can help them get their quality of life back.