Prolonged Menstrual Bleeding: Causes and Solutions - Obstetrics and Gynecology

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Prolonged menstrual bleeding, also known as menorrhagia, can be a distressing condition that significantly impacts a person's quality of life. It is characterized by heavy or prolonged menstrual bleeding that lasts more than seven days or requires changing sanitary protection every hour for several consecutive hours. In your case, experiencing a month-long menstrual cycle with intermittent bleeding can be particularly concerning, especially when accompanied by heavy bleeding after sexual intercourse.

There are several potential causes of prolonged menstrual bleeding, and understanding these can help guide appropriate treatment options. Some common causes include:
1. Hormonal Imbalances: Fluctuations in hormones, particularly estrogen and progesterone, can lead to irregular menstrual cycles and prolonged bleeding. Conditions such as polycystic ovary syndrome (PCOS) or thyroid disorders can contribute to these imbalances.

2. Uterine Fibroids: These are non-cancerous growths in the uterus that can cause heavy bleeding, prolonged periods, and discomfort. They can vary in size and number, and their presence can significantly affect menstrual flow.

3. Endometrial Hyperplasia: This condition involves the thickening of the uterine lining, often due to excess estrogen without enough progesterone. It can lead to heavy and prolonged menstrual bleeding.

4. Adenomyosis: This occurs when the tissue that normally lines the uterus grows into the muscular wall of the uterus, causing heavy bleeding and pain.

5. Infections: Pelvic inflammatory disease (PID) or sexually transmitted infections (STIs) can cause abnormal bleeding and should be ruled out, especially if there are accompanying symptoms like pain or unusual discharge.

6. Coagulation Disorders: Conditions that affect blood clotting can lead to heavy menstrual bleeding. If there is a family history of bleeding disorders, this may be a consideration.

7. Medications: Certain medications, especially anticoagulants or hormonal contraceptives, can affect menstrual bleeding patterns.

Given your symptoms, it is crucial to seek medical attention. A healthcare provider will likely perform a thorough evaluation, which may include a physical examination, pelvic ultrasound, blood tests, and possibly a biopsy of the uterine lining. These tests can help determine the underlying cause of your prolonged bleeding.

In terms of management, treatment options will depend on the identified cause. Some potential solutions include:
- Hormonal Treatments: Birth control pills, hormonal IUDs, or other hormonal therapies can help regulate menstrual cycles and reduce bleeding.

- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and reduce bleeding. Additionally, medications like tranexamic acid can help decrease menstrual blood loss.

- Surgical Options: In cases where fibroids or adenomyosis are present, surgical interventions such as myomectomy (removal of fibroids) or hysterectomy (removal of the uterus) may be considered, especially if other treatments are ineffective.

- Lifestyle Modifications: Maintaining a healthy diet, regular exercise, and managing stress can also contribute to overall reproductive health.

It is essential to address your concerns with a healthcare provider who can provide personalized advice and treatment options based on your specific situation. Do not hesitate to seek help, as prolonged menstrual bleeding can lead to complications such as anemia due to blood loss, and addressing the issue early can lead to better outcomes.