Excessive Menstrual Bleeding: Beyond Just Hemostatic Medications?

Q: Excessive Menstrual Bleeding: Beyond Just Hemostatic Medications?

Hello： 1. I often prescribe similar medications; you should consult your attending physician regarding the dosage. 2. This type of prescription can reduce menstrual flow, rather than preventing menstrual discharge. 3. For excessive menstrual bleeding, it is im

Gynecological issues - Is it only possible to take hemostatic medication for excessive menstrual bleeding?

Hello Doctor: I was referred to a gynecologist by my family medicine physician due to anemia (with a ferritin level of 2.83).
The gynecologist at another clinic suggested that the possible cause of my heavy menstrual bleeding could be a slightly thickened endometrium (approximately 0.9 cm on day 9 of my menstrual cycle).
I have been experiencing heavy menstrual bleeding for several years, but it has recently (over the past six months to a year, with a cycle of every 28 days) become progressively heavier.
The gynecologist prescribed the following medications to be taken during the first to third days of my menstrual period (to be taken three times a day after meals and once before bedtime): 1.
TRANSAMIN 250 mg (to control bleeding and improve inflammation and swelling symptoms) 2.
PONSTAN 500 mg (anti-inflammatory and pain relief) 3.
STROCAIN (gastric tablet) to be taken before meals.
I would like to ask: 1.
If I take these medications for three days each month (with a menstrual cycle of about 28 days), will the dosage be too heavy for me (my current weight is approximately 44 kg)? 2.
Are there any long-term side effects from taking these medications (for about a year and a half)? Could it lead to incomplete menstrual flow? 3.
Are there any other fundamental treatments for heavy menstrual bleeding? What should I pay attention to in my daily life? Thank you, Doctor!

Ai Mi, 30~39 year old female. Ask Date: 2006/09/29

Dr. Li Guanghan reply Obstetrics and Gynecology

Hello: 1.
I often prescribe similar medications; you should consult your attending physician regarding the dosage.
2.
This type of prescription can reduce menstrual flow, rather than preventing menstrual discharge.
3.
For excessive menstrual bleeding, it is important to check for potential gynecological issues such as fibroids, adenomyosis, or endometrial hyperplasia, as well as to investigate for underlying problems like thrombocytopenia or coagulation disorders.
You are welcome to visit us at the Department of Obstetrics and Gynecology, Hsinchu City Hospital.

Reply Date: 2006/09/29

More Info

Excessive menstrual bleeding, known medically as menorrhagia, can significantly impact a woman's quality of life and lead to complications such as iron deficiency anemia, as you've experienced. Your situation, characterized by heavy menstrual bleeding and a low ferritin level (2.83), indicates that your body is struggling to maintain adequate iron levels due to blood loss. The medications prescribed by your gynecologist, including Tranexamic Acid (TRANSAMIN), Mefenamic Acid (PONSTAN), and a gastric protective agent (STROCAIN), are commonly used to manage heavy menstrual bleeding and associated symptoms.

Addressing Your Questions:
1. Medication Dosage and Weight Considerations:
The dosage of medications like TRANSAMIN and PONSTAN is typically standardized, but individual responses can vary based on factors such as body weight, overall health, and the severity of symptoms. At a weight of 44 kg, the prescribed doses may seem high, but they are generally considered safe when monitored by a healthcare provider. It's crucial to follow your doctor's instructions and report any side effects or concerns you may have during treatment. Regular follow-ups can help assess the effectiveness of the treatment and make necessary adjustments.

2. Long-term Use and Side Effects:
Long-term use of these medications can lead to potential side effects. Tranexamic Acid is generally well-tolerated, but it can cause gastrointestinal disturbances, dizziness, or, in rare cases, thromboembolic events. Mefenamic Acid, a non-steroidal anti-inflammatory drug (NSAID), can lead to gastrointestinal issues, renal impairment, or increased bleeding risk if used excessively. While these medications help manage symptoms, they do not address the underlying cause of menorrhagia. It's essential to have regular check-ups to monitor your condition and any side effects from long-term medication use.

3. Underlying Causes and Treatment Options:
The thickening of the endometrium (the lining of the uterus) can lead to heavy bleeding. This condition can be due to hormonal imbalances, fibroids, polyps, or other uterine abnormalities. Treatment options may include hormonal therapies (like birth control pills), intrauterine devices (IUDs), or surgical interventions (like endometrial ablation or hysterectomy) depending on the underlying cause. It's essential to discuss these options with your gynecologist, who can provide tailored advice based on your specific situation.

Lifestyle and Management Tips:
- Dietary Adjustments: Focus on a diet rich in iron (e.g., red meat, leafy greens, legumes) and vitamin C (to enhance iron absorption). This can help manage your anemia.

- Hydration: Staying well-hydrated can help manage symptoms and overall health.

- Regular Monitoring: Keep track of your menstrual cycle, noting the flow, duration, and any associated symptoms. This information can be valuable for your healthcare provider.

- Stress Management: Stress can exacerbate menstrual symptoms, so consider practices like yoga, meditation, or other relaxation techniques.

Conclusion:
Managing excessive menstrual bleeding requires a comprehensive approach that includes medication, lifestyle adjustments, and regular medical evaluations. While the medications prescribed can help alleviate symptoms, it is crucial to address the underlying causes of menorrhagia for long-term relief. Regular communication with your healthcare provider is essential to ensure that your treatment plan is effective and safe. If you have ongoing concerns or if your symptoms worsen, do not hesitate to reach out to your gynecologist for further evaluation and potential adjustments to your treatment plan.

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