Dr Padmaja Koya – 
Heavy menstrual bleeding can indicate a more serious condition like uterine cancer.
Do you know when bleeding is normal and when it is not?
The menstrual cycle is a normal process that happens to nearly all women during their childbearing years, from puberty till menopause. Despite this, there are still a lot of inaccurate ideas revolving around menstruation.
What Constitutes Menorrhagia (heavy periods)?
Heavy menstrual bleeding is defined as blood loss greater than about 80 milliliters each cycle. Since it can be difficult to measure volume of menstrual blood loss, an easier indicator for doctors is the frequency at which a woman changes her sanitary pads or tampons, especially if she is requiring to use both a tampon and a pad (double protection) as well as passing clots, especially clots larger than 1” in diameter.
Serious condition
The need to continuously change sanitary protection can impact quality of life and health in general. Heavy menstrual bleeding can make it difficult for some women to carry out day-to-day responsibilities or to socialise. More importantly, menorrhagia may be a symptom of a more serious condition.
What Causes Heavy Periods and Abnormal Bleeding?
The female hormones estrogen and progesterone help prepare a woman’s body for a possible pregnancy by thickening the uterine lining, called the endometrium. If the released egg isn’t fertilized, hormone levels will go down and the body will shed the endometrium, producing the bleeding known as the menstrual period.
Hormone levels
Changes in hormone levels (especially for teenage girls), the approach of menopause, and using certain types of birth control can all trigger abnormal bleeding.
Too much or too little of a specific type of hormone may also be due to certain medications or thyroid problems.
Difficulties with blood clotting can be another cause of heavy menstrual bleeding in teenage girls. Remember that occasional menstrual clotting, with clots smaller than 1” in diameter is normal for some women.
Tell your doctor if you are concerned about menstrual clotting; a good way to keep track of the details is to keep notes for every day of your period, noting the size of clots and whether your flow is light or heavy.
Other causes
Other possible causes of abnormal or heavy menstrual bleeding include Uterine Fibroids, Endometrial Polyps, Infection, Uterine Cancer and Bleeding Disorders (like von Willebrand Disease).
When Should You See a Doctor for Abnormal Bleeding?
If menstrual bleeding seems excessive, lasts longer than a week, greatly impacts everyday life, or just seems different than the norm, make an appointment with a gynecologist.
Other signs that indicate the need for a visit to the doctor include bleeding between periods, after menopause, after sex.
Tests and Treatment
Your doctor can usually determine the cause of heavy menstrual bleeding by running a few tests. This usually involves blood tests to check for iron deficiency anemia and also for hormonal causes. They may also take a sample of tissue from the uterine lining, known as an endometrial biopsy, to check for abnormal cells, a potential indicator of cancer.
Other tests may involve ultrasound or use of a telescope to view inside the uterus (a hysteroscopy).
Depending on the cause and the individual patient’s needs, treatments may include hormones (birth control pills and IUDs – mirena), NSAIDs (such as ibuprofen and naproxen), the non-hormonal drug tranexamic acid and possibly surgery.
Surgical procedures
Surgical procedures like a hysterectomy, or less invasive procedures such as Endometrial Ablation, could be considered. Endometrial Ablation is a day-stay procedure with minimal down time and is suitable for older women. Hysterectomy would be required in some cases especially if conservative treatment fails.
Hysterectomy can be performed vaginally, abdominally or more commonly via laparoscope. The later approach has a quicker recovery and retune to work.
A common misconception is that hysterectomy will lead to menopause and weight gain. Neither of these is accurate.
Dr Padmaja Koya is a Gynaecologist Laparoscopic Surgeon, with special interest in Laparoscopy and Complex Laparoscopic surgery for Endometriosis, Uterine Fibroids and Ovarian Cysts. She also offers Colposcopy, surgical management of female incontinence and prolapse. Dr Koya regularly meets patients in her private clinic (on 161 Gilles Avenue in Auckland) and hospitals and performs various kinds of surgery related to her specialisation.
Photo :Dr Padmaja Koya
