Managing Heavy Menstrual Bleeding: Causes, Symptoms, and Treatments

What should I do if I have heavy menstrual bleeding?

Hello Dr.
Jan: I experience heavy menstrual bleeding that lasts for over a week each time, and I also feel dizzy and have abdominal pain.
I have consulted with a gynecologist, but there hasn't been much improvement.
I have four children; could having so many pregnancies affect my uterus's ability to contract properly? Does being overweight have an impact? Are there suitable medications or other treatments available?

Zhu Zhu, 40~49 year old female. Ask Date: 2004/03/09

Dr. Zhan Deqin reply Obstetrics and Gynecology

1.
Heavy menstrual bleeding can easily lead to anemia, and your dizziness may be caused by anemia.
A thorough examination is necessary, including a Pap smear, ultrasound, and pelvic examination, to determine the underlying cause.
2.
There are indeed medications available; certain hemostatic agents, uterotonics, or non-steroidal anti-inflammatory drugs (NSAIDs) can be effective when used in combination.
Additionally, taking progesterone preparations before the onset of menstruation can help reduce menstrual blood flow.

Reply Date: 2004/03/09

More Info

Heavy menstrual bleeding, also known as menorrhagia, is a common issue that can significantly impact a woman's quality of life. It is characterized by prolonged or excessive menstrual bleeding, often lasting more than seven days, and can be accompanied by symptoms such as fatigue, dizziness, and abdominal pain. Understanding the causes, symptoms, and treatment options is crucial for effective management.

Causes of Heavy Menstrual Bleeding
There are several potential causes of heavy menstrual bleeding, including:
1. Hormonal Imbalances: Fluctuations in hormones, particularly estrogen and progesterone, can lead to irregularities in the menstrual cycle and increased bleeding.

2. Uterine Fibroids: These non-cancerous growths in the uterus can cause heavy bleeding, especially if they are located near the uterine lining.

3. Adenomyosis: This condition occurs when the tissue that normally lines the uterus grows into the muscular wall of the uterus, leading to heavy and painful periods.

4. Endometrial Polyps: These are growths on the inner wall of the uterus that can cause heavy bleeding.

5. Medical Conditions: Conditions such as thyroid disorders, bleeding disorders (like von Willebrand disease), and pelvic inflammatory disease can also contribute to heavy menstrual bleeding.

6. Obesity: Excess body weight can lead to hormonal imbalances that may increase menstrual bleeding.

7. Age and Childbirth History: Women who have had multiple pregnancies may experience changes in their uterine structure and function, which can affect menstrual bleeding.

Symptoms
In addition to heavy bleeding, symptoms may include:
- Severe cramping or abdominal pain
- Fatigue or weakness due to blood loss
- Dizziness or lightheadedness
- Clots larger than a quarter
- Interference with daily activities due to bleeding

Treatment Options
Managing heavy menstrual bleeding often requires a multifaceted approach. Here are some common treatment options:
1. Medications:
- Hormonal Treatments: Birth control pills, hormonal IUDs, or other hormonal therapies can help regulate menstrual cycles and reduce bleeding.

- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen can help reduce menstrual flow and alleviate pain.

- Desmopressin: For women with bleeding disorders, this medication can help increase clotting factors.

2. Surgical Options:
- Uterine Fibroid Embolization: This procedure blocks blood flow to fibroids, causing them to shrink.

- Endometrial Ablation: This technique destroys the uterine lining to reduce or stop bleeding.

- Hysterectomy: In severe cases, removing the uterus may be necessary, especially if other treatments fail.

3. Lifestyle Changes:
- Weight Management: Maintaining a healthy weight can help balance hormones and reduce symptoms.

- Diet and Nutrition: A balanced diet rich in iron can help combat fatigue from blood loss.

4. Alternative Therapies: Some women find relief through acupuncture, herbal supplements, or other complementary therapies, although these should be discussed with a healthcare provider.

Conclusion
Given your history of having four children, it is possible that your uterine structure has changed, which could contribute to your symptoms. Additionally, being overweight can influence hormonal balance and exacerbate heavy bleeding. It is essential to work closely with a healthcare provider to explore these factors and develop a tailored treatment plan. If you have not found relief with previous treatments, consider seeking a second opinion or consulting a specialist in reproductive endocrinology or a gynecologist with experience in managing menorrhagia. Regular follow-ups and monitoring are crucial to ensure effective management of your condition and to address any underlying issues.

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