Dr. Shashikala Ksheerasagar

Excess bleeding or menorrhagia is a common kind of abnormal bleeding occurring at the time of menstruation. Menorrhagia causes more blood loss which leads to anaemia. fatigue and breathlessness are common symptoms of anaemia.

Symptoms of excess bleeding

A few of the common symptoms of excessive bleeding are: 

1. Discharge of large blood clots is a sign of heavy bleeding 
2. Bleeding during the night which causes disruption in sleep as one has to wake up several times in the night to change the sanitary napkin 
3. Menstruation lasts longer than usual or more than 5 to 7 days. 
4. Any menses requiring excess change of pads than usual 

Causes of excess bleeding 

1. Imbalance of hormones: During adolescence and when nearing menopause, the female body undergoes some imbalance in oestrogen and progesterone hormones. At these points of time, heavy bleeding is common among women. But it’s abnormal. So get it evaluated. 
2. Abortion / Ectopic pregnancy: Conception occurs in mid cycle and so by the time a menses start, one could be a pregnant too. So excess bleeding occurring at menses could be also due to an abortion or miscarriage. Unlike the usual course of pregnancy, if the fertilised egg gets stuck in the fallopian tubes and develops there, It results in Ectopic pregnancy. Excess bleeding can be a sign of ectopic pregnancy too.
3. Fibroids: Growth of fleshy solid tumours in the wall of uterus namely Fibroids can lead to excess bleeding. 
4. Cancer: Cervical, ovarian and uterine cancers are rare causes of heavy bleeding, but it is possible. So early detection of these conditions is better for treatment. 
5. Adenomyosis: This is common in middle-aged women who have given birth to more than two children. In this case, the glands that appear in the lining of the uterus become deeply embedded in the muscle of the uterus wall. These women with adenomyotic uterus have severe dysmenorrhea ( pain during menses ) and excess bleeding. 
6. Intrauterine device: IUD used for birth causes more bleeding during menstruation. In some the bleeding reduces over time, but if in excess one must get evaluated. 
7. Pelvic inflammatory disease: PID is an infection that occurs in the uterus, other reproductive organs and the fallopian tubes. Inflammed reproductive organs bleed more and hence cause menorrhagia. 
8. Other diseases and disorders: Diseases like that of liver, kidneys and thyroids can cause excess bleeding. Disorders in blood levels or platelets can also be a cause. 

Treatment for excess bleeding 

Several treatments are available to treat heavy bleeding during menstruation. Choosing the right one mainly depends on the reasons that cause heavy bleeding.

Non-surgical treatments: 

1. Hormonal therapy: This therapy is used as a treatment to stabilise the lining of the uterus (endometrium) and thus regulate the menstrual bleeding. 
2. Non-hormonal medication: A tranexamic acid is a non-hormonal medication prescribed by the doctor that promotes clotting of the blood.
3. Nonsteroidal drugs: Nonsteroidal medications that are anti-inflammatory like Ibuprofen, mefenamic acid helps to reduce the blood loss. 

Surgical Treatments 

1. Hysteroscopy: A long and thin scope can be inserted into the uterus through the cervix and the vagina. The doctor observes the lining of the uterus, remove the excess lining or the endometrial polyps that cause bleeding. 
2. Dilation and curettage: In this procedure, the mouth of the uterus (cervix) to be dilated and the lining of the uterus is scrapped off to make it shed all at once and stop bleeding. 
3. Hysterectomy: This involves removing the uterus. It is mainly done for uterus having adenomyosis, fibroids, or cancers, or when the patient does not respond to medical therapies. 
4. Ablation: Ablation or endometrial resection allows removal of the lining of the uterus. But it may be a temporary measure as the lining recurs. 

To conclude, proper diagnosis, choosing the right treatment for excess bleeding at menses needs to be done urgently as it affects the overall health of the women suffering from it. If you wish to discuss about any specific problem, you can consult a Gynaecologist.