Prolonged Menstrual Bleeding: Causes and Treatment Options

Persistent bleeding

Hello, Doctor.
My menstrual cycle has been very regular (28 days) and lasts slightly longer (6 days).
This time, the first day of my period was on October 29, and it has continued until now, November 11, making it 14 days.
I visited the outpatient clinic on November 7 and received medication for uterine contractions, hemostatic agents, iron supplements, gastric medication, and pain relief.
I have been taking the medication for four days, but the bleeding has not improved; instead, there are more blood clots, and the blood is bright red.

1.
Are the blood clots continuously forming and then shedding?
2.
Should I continue taking the medication until there is improvement?
3.
Should I switch to hormonal medication for hemostasis until my next menstrual period? What should I do if the bleeding does not stop? What if I continue to bleed during my next cycle?
4.
What could be the underlying cause? How can I regulate my body? Thank you, Doctor.

Niming, 30~39 year old female. Ask Date: 2015/11/11

Dr. Lin Wenbin reply Obstetrics and Gynecology

The formation and shedding of blood clots is a medical explanation.
It is most important for you to ask your prescribing physician directly during your outpatient visit.
The physician's assessment requires an in-person examination to be clear.

Reply Date: 2015/11/11

More Info

Prolonged menstrual bleeding, also known as menorrhagia, can be a concerning issue for many women. It is defined as menstrual bleeding that lasts longer than seven days or is excessively heavy. In your case, experiencing 14 days of bleeding with the presence of blood clots is certainly outside the norm and warrants further investigation and management.

1. Understanding Blood Clots
The presence of blood clots during menstruation can be attributed to several factors. Blood clots are typically formed when the body is unable to break down the blood quickly enough, leading to pooling and clotting. In your situation, the fact that you are experiencing new clots suggests that your body is still producing excess endometrial tissue, which is being shed during your prolonged bleeding. This could indicate an underlying issue such as hormonal imbalances, uterine fibroids, polyps, or even more serious conditions like endometrial hyperplasia or malignancy.

2. Medication Management
You mentioned that you have been prescribed uterotonics (medications to help the uterus contract), hemostatic agents (to help with bleeding), iron supplements (to combat anemia), and pain relief medications. If you have been taking these medications for four days without improvement, it may be time to reassess your treatment plan with your healthcare provider. It is essential to follow your doctor's advice regarding the duration of medication use. If the current regimen is not effective, your doctor may consider adjusting your treatment.

3. Hormonal Therapy
Hormonal treatments can be effective in managing prolonged menstrual bleeding, especially if the bleeding is due to hormonal imbalances. Medications such as birth control pills or progestins can help regulate your menstrual cycle and reduce the heaviness of bleeding. If your bleeding does not improve with the current medications, discussing the option of hormonal therapy with your healthcare provider may be beneficial. It is crucial to monitor your symptoms closely and communicate any changes to your doctor.

4. Potential Causes
The causes of prolonged menstrual bleeding can vary widely. Common causes include:
- Uterine Fibroids: Noncancerous growths in the uterus that can cause heavy bleeding.

- Endometrial Polyps: Growths on the inner wall of the uterus that can lead to irregular bleeding.

- Hormonal Imbalances: Conditions such as polycystic ovary syndrome (PCOS) can disrupt normal menstrual cycles.

- Coagulation Disorders: Conditions that affect blood clotting can lead to heavier menstrual bleeding.

- Thyroid Disorders: Both hyperthyroidism and hypothyroidism can impact menstrual cycles.

5. Lifestyle and Dietary Adjustments
To help manage your symptoms and improve your overall health, consider the following lifestyle and dietary adjustments:
- Balanced Diet: Ensure you are consuming a diet rich in iron (to combat anemia), vitamins, and minerals. Foods like leafy greens, lean meats, beans, and fortified cereals can be beneficial.

- Hydration: Staying well-hydrated can help your body manage blood volume and circulation.

- Regular Exercise: Engaging in regular physical activity can help regulate hormones and improve overall health.

- Stress Management: High-stress levels can impact hormonal balance, so incorporating stress-reducing techniques such as yoga, meditation, or deep-breathing exercises can be helpful.

Conclusion
In summary, prolonged menstrual bleeding can have various causes and requires careful evaluation and management. It is essential to maintain open communication with your healthcare provider, especially if your symptoms persist or worsen. If you experience any additional concerning symptoms, such as severe pain, dizziness, or signs of anemia (like extreme fatigue or pallor), seek medical attention promptly. Your health and well-being are paramount, and addressing these issues early can lead to better outcomes.

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