Abnormally heavy menstruation?

The Straits Times

1 Sep 2015

Abnormally heavy menstruation?

If you feel your menstrual flow is abnormally heavy, do not just dismiss it. You may need to get it checked to rule out serious problems.

According to Dr Cynthia Kew, a consultant obstetrician and gynaecologist in private practice at Mount Elizabeth Novena Hospital, you have abnormally heavy menstrual bleeding or menorrhagia if you:

• Use more than one tampon or pad every one to two hours
• Use two pads to manage the flow
• Need to wake up in the middle of the night to change pads due to overflow
• Pass blood clots during your menstrual flow for more than a day
• Suffer from symptoms of anaemia such as fatigue or breathlessness.

Other warning signs include periods that last more than a week and if your daily physical activities are restricted by the heavy flow.

Menorrhagia can be caused by hormone imbalance, uterine fibroids or benign tumours of the uterus, pregnancy complications, cancer and certain medications.

It may go on to cause other medical conditions, such as iron deficiency anaemia and severe pain.

There are various treatments, but several may impact one’s fertility, and may not be suitable for women trying to get pregnant.

Dr Kew outlines some options:

1. Oral medications: These can be used as the initial treatment for women with heavier menses, and who either do not show symptoms suggestive of serious underlying causes, or are waiting for investigations to be carried out.

   For instance, non-steroidal anti-inflammatory drugs like ibuprofen, mefenamic acid, and naproxen can be used during one’s period to reduce bleeding.

   Oral contraceptive pills are also effective in reducing menstrual flow and regulating the menstrual cycle.

   Taking the hormone progesterone can help shorten the duration of menstrual flow if there is prolonged bleeding, but it does not have a contraceptive effect.

2. Progesterone injections: This can help to reduce menstrual flow, but it needs to be given every 12 weeks. Also, those who want to conceive have to take note that it usually takes six to 12 months for the menses to return after you stop the injections.
3. Surgery: This may be required if there are growths like uterine fibroids or adenomyosis, which cause an enlargement of the womb; or if drug therapy does not work.

   For instance, endometrial ablation is done to permanently destroy the lining of the uterus.

4. Non-surgical treatments: They include uterine artery embolisation and focused ultrasound surgery for uterine fibroids that can help reduce menstrual bleeding.

However they are not recommended for women who may wish to conceive as there is insufficient evidence to show the treatments would not affect their fertility or give rise to increased pregnancy risks.

“If one experiences the symptoms of an abnormal menstrual pattern, it is very important to see a gynaecologist for further evaluation and advice,” said Dr Kew.

“Otherwise, there may be a delay in diagnosing conditions like fibroids or even cancer.”