Heavy Menstrual Bleeding: Causes, Treatments, and Concerns

Questions about medication?

Hello, Doctor: My menstrual cycle is normal, with occasional cramps.
However, in recent months, I have experienced increased blood flow (with clots) lasting over 8 days.
I first visited a gynecology clinic, where a Pap smear came back normal, and an abdominal ultrasound showed no issues.
The doctor prescribed Primolut 5mg tablets, to be taken two a day.
However, during my menstruation in September, the blood flow (with clots) was excessive, and I experienced severe cramps, weakness, blurred vision, instability while standing, dizziness, and nausea/vomiting.
Therefore, I sought another clinic, where a transvaginal ultrasound also showed no abnormalities.
The doctor explained that the previous medication was insufficient, leading to poor uterine contractions and excessive blood flow, resulting in anemia, rather than being caused by pre-existing anemia.
I was advised to take iron supplements and prescribed the following medications: 1.
Ergonovine 2.
Panadol 500mg 3.
Tranexamic acid 250mg, to be taken four times a day during menstruation.
If there is no improvement, hormonal contraceptives may be needed to control uterine contractions.
Given this situation, what exactly is wrong with my body? What disease could this be? Will taking contraceptive pills cause other side effects? Will it affect my future fertility? Should I seek another physician for further evaluation? I am already feeling scared and panicked due to this abnormal menstrual cycle.
Thank you!

Chuan Chuan, 30~39 year old female. Ask Date: 2010/10/16

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, your issue can be further evaluated with a blood test to rule out other causes.
If it is simply heavy menstrual bleeding without any other endocrine or structural issues, increasing the dosage of progesterone may be beneficial.
A common regimen is 20 mg per day for 12-14 days, which generally yields good results.
If necessary, medications that promote uterine contractions can be used during menstruation.
For cases of heavy menstrual bleeding related to hormonal imbalances, oral contraceptives can also be an effective option, and they typically do not cause side effects if not used long-term.
If there are other underlying causes, further investigation and treatment will be required.
Thank you! Dr.
Zhang

Reply Date: 2010/10/16

More Info

Heavy menstrual bleeding, also known as menorrhagia, can be a distressing condition that significantly impacts a woman's quality of life. Based on your description, it seems you have been experiencing prolonged and heavy menstrual bleeding, accompanied by severe pain and symptoms of weakness, which are concerning. Let's break down the potential causes, treatments, and considerations regarding your situation.

Causes of Heavy Menstrual Bleeding
1. Hormonal Imbalances: One of the most common causes of heavy menstrual bleeding is hormonal imbalances, particularly involving estrogen and progesterone. These hormones regulate the menstrual cycle, and any disruption can lead to excessive bleeding.

2. Uterine Fibroids: Noncancerous growths in the uterus can cause heavy bleeding. They can vary in size and number, and while they are often benign, they can lead to significant symptoms.

3. Endometrial Hyperplasia: This condition involves the thickening of the uterine lining, which can lead to heavy bleeding. It may be a precursor to endometrial cancer, especially in women with prolonged exposure to estrogen.

4. Polycystic Ovary Syndrome (PCOS): This hormonal disorder can lead to irregular periods and heavy bleeding due to the lack of ovulation.

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

Treatment Options
1. Medications:
- Hormonal Treatments: Birth control pills can help regulate menstrual cycles and reduce bleeding. However, they may have side effects, including mood changes, weight gain, and potential impacts on future fertility, though these are generally minimal.

- Tranexamic Acid: This medication helps reduce bleeding by promoting blood clotting.

- Ergonovine: This medication can help the uterus contract and reduce bleeding.

- Iron Supplements: Given your symptoms of weakness and potential anemia, iron supplementation is crucial to replenish lost iron due to heavy bleeding.

2. Surgical Options: If medications do not alleviate the symptoms, surgical options such as endometrial ablation (removal of the uterine lining) or myomectomy (removal of fibroids) may be considered.

Concerns and Considerations
- Anemia: Your symptoms of dizziness, weakness, and nausea may indicate anemia due to heavy blood loss. It's essential to monitor your hemoglobin levels and overall health.

- Fertility: While hormonal treatments and certain surgical options can affect future fertility, many women successfully conceive after treatment. Discuss your concerns with your healthcare provider, as they can provide tailored advice based on your health history.

- Seeking Further Evaluation: If your symptoms persist despite treatment, or if you feel uncomfortable with the current management plan, seeking a second opinion from another gynecologist or a specialist in reproductive endocrinology may be beneficial. They can provide additional insights or alternative treatment options.

Conclusion
Heavy menstrual bleeding can stem from various causes, and it’s crucial to identify the underlying issue to determine the best treatment approach. Your current treatment plan, including medications and lifestyle adjustments, is a step in the right direction. However, ongoing communication with your healthcare provider is essential to ensure that your symptoms are managed effectively and to address any concerns about your health and future fertility. Remember, you are not alone in this, and seeking support from healthcare professionals can help alleviate your fears and guide you toward recovery.

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