Dr Maxwell Adeyemi
Menorrhagia - heavy or prolonged menstrual bleeding - can be caused by a number of medical issues, including fibroids, uterine polyps, perimenopause, and other factors.
Chronic (prolonged) or heavy periods can lead to complications such as iron-deficiency anaemia. A typical period lasts four or five days. During that time, an individual sheds two to three tablespoons of blood. Those with menorrhagia can lose twice as much blood each month. Over time, repeated monthly loss of blood during menstruation often lead to anaemia or low blood count in women.
The following indicate menorrhagia, they are signs that you are losing too much blood during your period:
• Bleeding for seven or more days
• Needing to change a pad or tampon every hour for several hours
• Wearing more than one pad at a time in order to control the bleeding
• Having to change your tampon or pad in the middle of the night
• Passing menstrual blood that contains clots that are the size of a quarter or bigger
CAUSES OF MENORRHAGIA
There are a number of different causes of heavy menstrual bleeding:
Ovulatory dysfunction:
The most common cause of heavy menstrual bleeding is ovulatory dysfunction during adolescence or perimenopause. During this time, ovulation (releasing an egg) can be irregular, which means it might not happen every month. This can lead to thickening of the endometrium (uterine lining) and heavy periods.
Oral contraceptives can usually regulate your bleeding during adolescence, and hormone therapy can help during menopause.
Beyond the normal hormonal changes that occur with puberty or menopause, hormonally induced ovulatory dysfunction can also occur with hypothyroidism, polycystic ovary syndrome, and premature ovarian insufficiency and sometimes these may cause bleeding issues.
Uterine fibroids
Fibroids are growths that develop from the muscle of the uterus, usually between ages 30 to 49 but can occur earlier.
Uterine fibroids need oestrogen to grow. Hormonal birth control methods, like birth control pills, can help reduce heavy menstrual bleeding from fibroids.
If bleeding is not severe, a wait-and-see approach can be adopted because as menopause becomes established, fibroids typically shrink and disappear without treatment.
Progestin-releasing intrauterine devices can decrease menstrual bleeding but do not reduce fibroid size. Injectable gonadotropin-releasing hormone agonists can decrease the size but can only be used for a short time due to their side effects.
Endometrial ablation, in which the lining of the uterus is destroyed, is a procedure that can be used for the treatment of small fibroids.
Surgical options include myomectomy (removal of the fibroid) and uterine artery embolisation which cuts off the blood supply to the fibroid.
In the most severe cases, a hysterectomy may be warranted, in which the whole uterus is removed, with or without the ovaries.
Uterine Polyps
Endometrial polyps are typically non-cancerous, grape-like growths that pr
