Prolonged Menstrual Bleeding: Causes and When to Seek Help - Obstetrics and Gynecology

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Prolonged menstrual bleeding, also known as menorrhagia, can be a concerning issue for many women. When menstrual bleeding lasts longer than seven days or is excessively heavy, it can lead to significant health problems, including anemia and fatigue. In your case, experiencing a month-long period with sudden increases in flow and the presence of blood clots is particularly noteworthy and warrants further investigation.

There are several potential causes of prolonged menstrual bleeding. These can include hormonal imbalances, uterine fibroids, polyps, adenomyosis, endometriosis, and certain medical conditions such as thyroid disorders or clotting disorders. Hormonal imbalances, particularly involving estrogen and progesterone, can lead to irregular and heavy menstrual bleeding. Uterine fibroids and polyps are non-cancerous growths that can develop in the uterus and cause heavy bleeding. Adenomyosis occurs when the tissue that normally lines the uterus grows into the muscular wall of the uterus, leading to painful and heavy periods. Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus, which can also cause heavy bleeding and pain.

Given that your bleeding has persisted for over a month and has changed in volume and character, it is crucial to seek medical attention. Here are some signs that indicate you should see a healthcare provider promptly:
1. Heavy Bleeding: If you are soaking through one or more sanitary pads or tampons every hour for several consecutive hours.

2. Blood Clots: Passing large blood clots (larger than a quarter) can indicate a more serious issue.

3. Severe Pain: If you are experiencing severe abdominal or pelvic pain that is not relieved by over-the-counter pain medications.

4. Fatigue or Weakness: If you feel unusually tired, weak, or dizzy, this could be a sign of anemia due to blood loss.

5. Duration: If your menstrual bleeding lasts longer than seven days, it is advisable to consult a healthcare provider.

When you visit a healthcare provider, they will likely conduct a thorough evaluation, which may include a physical examination, pelvic exam, and possibly imaging studies such as an ultrasound. Blood tests may also be performed to check for anemia and hormonal levels. Depending on the findings, treatment options may vary. They could include hormonal therapies (such as birth control pills), medications to help reduce bleeding (like tranexamic acid), or surgical options if structural issues like fibroids or polyps are identified.

In the meantime, it is essential to take care of your overall health. Ensure you are staying hydrated, eating a balanced diet rich in iron and vitamins, and managing any discomfort with appropriate pain relief methods. If you experience any of the warning signs mentioned above, do not hesitate to seek medical attention immediately.

In summary, prolonged menstrual bleeding can have various underlying causes, and it is crucial to seek medical advice to determine the cause and appropriate treatment. Early intervention can help prevent complications and improve your quality of life.