Heavy menstrual bleeding (HMB) or menorrhagia is one of the most common reasons for which women seek a Gynaecologists help. There are over 355 million menstruating women in India and about 60% of them may need medical help at some time in their lives to deal with heavy periods.Why do women have periods?Imagine a life without periods - no bleeding, no pain, no sanitary napkins and no tampons .freedom. Before you get too carried away with that utopian thought have you ever wondered why women have periods? Well, because we are special of course! Every month the womb prepares for a possible pregnancy and when this does not happen it sheds the lining of the womb which results in a period or menses. This usually happens once a month and a woman bleeds on an average for 5 days. The normal cycle varies from 21 to 35 days and the bleeding can last from 2 to 7 days. So, having a regular period most often indicates that a woman is ovulating every month. So ladies the next time you moan about your periods remember it is your monthly reminder that you are capable of having a baby!

How do I know if I have HMB?Do have heavy periods, needing constant change of menstrual hygiene wear, staining of clothes, cramps and severe pain in your tummy? Are you personal and professional life affected during your period days such that you cannot maintain your usual activities? Do you dread that time of the month? If the answer to most of the questions is yes, you are suffering from heavy periods and you need to see a doctor.

Symptoms of HMB

If you have any of the following symptoms you may be suffering from heavy menstrual bleeding and may need medical help:Soaking through one or more sanitary pads or tampons every hour for several consecutive hoursNeeding to use double sanitary protection to control your menstrual flowNeeding to wake up to change sanitary protection during the nightBleeding for longer than a weekPassing blood clots larger than a quarterRestricting daily activities due to heavy menstrual flowSymptoms of anemia, such as tiredness, fatigue or shortness of breath

What are the causes of HMB?About 60% of the women who consult me, do so because they have a menstrual problem. Heavy periods can be caused by hormone problems, uterine problems and other causes. Given below is a brief overview of the causes of heavy bleeding.

Hormone imbalanceIn a normal menstrual cycle, a balance between the hormones estrogen and progesterone regulates the buildup of the lining of the uterus (endometrium), which is shed during menstruation. If a hormone imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding.A number of conditions can cause hormone imbalances, including polycystic ovary syndrome (PCOS), obesity, insulin resistance and thyroid problems.Uterine fibroids - These are benign tumors of the uterus which may cause heavier than normal or prolonged menstrual bleeding.

Uterine Polyps - Small, benign growths on the lining of the womb cause heavy or prolonged or irregular menstrual bleeding.Adenomyosis - This condition usually affects women in their forties. Glands of the lining of the uterus become embedded in the muscle of the uterus and cause heavy, painful periodsIntrauterine device (IUD) - Menorrhagia is a side effect of using a nonhormonal intrauterine device for birth control.

Cancer - Uterine cancer and cervical cancer can cause excessive menstrual bleeding, especially if you are postmenopausal or have had an abnormal Pap test in the past.Inherited bleeding disorders - Some bleeding disorders such as von Willebrand's disease, a condition in which an important blood-clotting factor is deficient or impaired can cause abnormal menstrual bleeding.Medications - Certain medications like anticoagulants or blood thinners, can cause heavy menstrual bleeding.

Other medical conditions - A number of other medical conditions, including liver or kidney disease, may be associated with menorrhagia.

HMB Treatment options in the 21st Century

Treatment depends on the under lying cause of HMB can be divided into Medical, Surgical and Non-Surgical Procedures.

Medical

Drugs: The most commonly used non-hormonal drugs are Tranexamic Acid and Mefenamic Acid.

The Combined oral Contraceptive pill and Progesterones are hormonal drugswhich are used to treat this condition.

A hormonal Intra uterine device or system (IUS) has a small amount of progesterone hormone impregnated into it and releases it locally. It is inserted into the uterus and acts by thinning the lining of the womb, thus reducing the amount of blood lost during menstruation. Research has shown that this is the most effective form of medical treatment in suitable women.

Surgical and non-surgical proceduresHysteroscopy and/or Laparoscopy: If the HMB is due to fibroids or polyps these can be surgically removed by Hysteroscopy and/or Laparoscopy or by the traditional open method.

Endometrial Ablation: This procedure involves destroying (ablating) the lining of the womb (endometrium). The procedure uses a laser, radiofrequency or heat applied to the endometrium to destroy the tissue.

Endometrial resection: In this procedure an electrosurgical wire loop is used to remove the lining of the womb.This results in lighter bleeding. However, in women considering a pregnancy this procedure is not recommended.

Uterine artery embolization: When HMB is caused by large fibroids (more than 3 cm) this procedure helps shrink the fibroids (in selected cases) by blocking the uterine arteries and cutting off the blood supply to the fibroids. During this procedure, the doctor passes a catheter through the large artery in the thigh (femoral artery) and guides it to the uterine arteries, where the blood vessel is injected with materials that decrease blood flow to the fibroid.

HIFU: High Intensity Focused ultrasound is a non-invasive way to treat uterine fibroids. Using this treatment method in conjunction with image guidance, the physician directs a focused beam of energy through the patients skin, superficial fat layer, and abdominal muscles to heat and destroy the fibroid tissue without damaging nearby tissue or the tissues that the beam passes through on its way to the target.The treatment is conducted with the patient awake and uses either magnetic resonance (MR) or ultrasound (US) guidance.

Link:
Heavy menstrual bleeding What you should know - Times of India

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