Go With The Flow

Heavy Menstrual Bleeding – The Only Guide You Will Need

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Do you find yourself unable to complete your usual daily chores and activities due to a drastic drop in productivity levels on the days of your period due to heavy periods? No matter where you are headed, do you have to carry a bag filled with extra sanitary pads and a change of clothes? Are you missing out on an active social life because of heavy bleeding?

If you have said yes to all the questions above, you might be suffering from heavy menstrual bleeding.

Often, women with heavy menstrual bleeding accept that periods are supposed to be an uncomfortable experience because they have grown up seeing their mothers, sisters, and aunt face heavy periods without complaint. It’s high time that we strive to overcome the social stigma linked with periods by initiating an open conversation on heavy menstrual bleeding.

Heavy Menstrual Bleeding - A Brief Overview

As per the World Health Organization, almost 19 million women worldwide aged thirty to fifty-five experience menstrual bleeding that can be deemed excessive. While the reasons for heavy periods may differ, its basic symptoms can be agreed upon.

Heavy Menstrual Bleeding, also known as menorrhagia, is clinically defined as the total amount of blood loss exceeding 80ml per menstrual cycle. But how can we know how much period blood constitutes 80ml? When you notice your period exceeding a week in duration and a experience a continuous ‘gushing out’ feeling, it can confirm heavy menstrual bleeding.

Top gynecologists across the cities in the country have revealed that more than 60% of their consultations involved a case of heavy menstrual bleeding. This compels us to think about the thousands of women in the rural towns and villages whose instances of heavy menstrual bleeding go unaddressed due to a lack of education around this condition.

Studies show that approximately 53 in every 1000 menstruating women in India suffer from heavy menstrual bleeding during at least one stage in their lives. In case heavy flow during periods are consistently interfering with your quality of life on multiple fronts, you must raise your awareness about heavy menstrual bleeding and get in touch with a doctor.

To help you seek better care, we bring you this RIO special guide on dealing with menstrual bleeding, its causes, symptoms, possible treatments, and complications.

Causes of Heavy Menstrual Bleeding

Let’s take a look at the possible causes of heavy blood loss during menstruation:

  1. Hormonal Imbalance - A change or imbalance in the primary female sex hormones - estrogen and progesterone can cause heavy menstrual bleeding because these hormones are responsible for regulating your periods. This imbalance can be caused by:
    1. Stress
    2. Thyroid Disease - Both hyperthyroidism and hypothyroidism can contribute to prolonged periods.
    3. Polycystic Ovary Syndrome (PCOD) - PCOD causes an abnormal secretion of hormones that affect your ovaries’ functioning. The symptoms include irregular and heavy periods, excess body hair, and acne. It affects your ovulation and metabolism as well.
    4. Anovulation - During a menstrual cycle, one of your ovaries releases an egg for ovulation. However, when neither of your ovaries releases an egg, it causes anovulation, resulting in heavy periods.
    5. Menopause
  2. Uterine polyps and fibroids – The non-malignant growths of varying sizes present in the womb (uterus) and its lining increase your hormone levels and result in heavy menstrual bleeding.
  3. Cancer- It is a wise idea to get all the benign growths removed through polypectomy as they have the potential of evolving into life-threatening cancer. Heavy menstrual bleeding and blood clots are considered early signs of cervical and endometrial cancer
  4. Pregnancy-related complications - The fertilized egg implants itself in the fallopian tube instead of the uterus in an ectopic pregnancy. The fallopian tube is incapable of stretching and holding the growing egg, which leads to bleeding in the mother. Even a miscarriage can cause heavy bleeding.

Also, birth through a c-section often leaves a scar that creates a pocket in the uterus that can collect excess blood that passes out during a period.

  1. Adenomyosis - Here, the endometrial glands break out of the muscular uterine walls (myometrium) in the form of small pockets and lead to heavy menstrual bleeding,
  2. Endometriosis refers to a condition where the endometrium - the innermost lining of the uterus starts to travel outside of the womb and grow on organs like the fallopian tube, ovaries, or bowel. This is known to cause heavy and painful periods.
  3. Pelvic inflammatory disease (PID) – This infection of one or more female reproductive organs such as the ovary, uterus, and fallopian tubes can cause heavier menstrual flow than average.
  4. Endometrial hyperplasia – In this condition, a rise in estrogen levels causes the endometrium to become abnormally thick and cause heavy menstrual bleeding.
  5. Medication - Blood thinners and antiplatelet drugs like aspirin can cause heavy bleeding on periods. Hormone replacement therapy and breast cancer drugs also lead to heavy menstrual bleeding. Even herbal supplements like soy, ginseng, and ginkgo extracts can result in heavy periods.
  6. Chronic illnesses like kidney or liver disease also lead to heavy periods.

Telltale Symptoms to Watch Out For

There is no one single parameter to define a heavy flow since the amount of blood loss during a period is uniquely personal to every woman on this planet.

However, there are some common signs that can be surely attributed to heavy menstrual bleeding:

  • Your menstrual cycle lasts for more than a week due to heavy bleeding.
  • You need to change your tampon or pad once every hour for over 24 hours because the ones you are wearing are completely soaked.
  • Having to empty your menstrual cup much more often than the usual
  • You have an excessive blood flow that requires you to change your pad or tampon even in the middle of the night.
  • Bleeding through to your clothes and staining the bedding even after wearing the largest size of the sanitary pad
  • You have to wear more than one sanitary pad or use both a pad and tampon together to deal with the high intensity of the period flow.
  • Release of several blood clots or lumps that are larger than the Rs 2 coin along with the menstrual blood
  • Severe and constant cramps or pain in the lower abdomen and pelvic floor when you are on your period

Who Is At High Risk?

Any woman of reproductive age can experience heavy menstrual bleeding. Still, teens in the menarche phase and women approaching menopause tend to be at the highest risk of this condition. This is because heavy menstrual bleeding is directly linked with high estrogen levels and low progesterone levels, mainly seen during the start and end of menstrual cycles in a woman’s life.

Also, the human body is sensitive to change, and bodily transitions can significantly affect your menstrual cycle.

Older Women - In the medical investigations of nearly half of all women suffering from heavy menstrual bleeding, no obvious abnormality in their organs can be detected. This is called ‘Abnormal Uterine Bleeding,’ commonly seen in women between thirty to fifty. Alongside, the uterine fibroids tend to enlarge and act as a severe blockage to the flow of the period blood in the pre-menopausal phase.

Thus, older women are at a high risk of heavy periods due to their changing hormones.

Obese women - According to a study in the Journal of Endocrinology, obesity is associated with heavy bleeding due to a more inflammatory uterine environment and delay in repairing the uterus lining. That is why obese women with a high Body Mass Index (BMI) are at a greater risk of experiencing heavy menstrual bleeding.

Women who use a non-hormonal IUD - An intrauterine device (IUD) is one of the most popular birth control measures. But women who use an IUD that does not contain any hormones like a copper IUD are at extremely high risk of heavy menstrual bleeding. A Copper IUD can irritate your uterus and increase the level of prostaglandin - a hormone that causes heavy bleeding during periods.

A significant risk factor for heavy menstrual bleeding will be a family history of bleeding disorders such as -

  • Von Willebrand disease - Genetic bleeding disorders like von Willebrand’s disease are characterized by the lack of a critical blood-clotting protein known as the von Willebrand factor. This deficiency can be one of the heavy period causes.
  • Platelet disorders - Platelet disorders like thrombocytopenia result in prolonged periods as the platelets fail to perform their clotting function.
  • Hemophilia - Carrying a hemophilia gene will also cause you to experience heavy menstrual bleeding and excessive bleeding due to injury.

Complications Associated with Heavy Menstrual Bleeding

The harmful effects of heavy menstrual bleeding go way beyond the inconvenience of bleeding for too long. If left undiagnosed, heavy bleeding causes such complications -

  • Anemia - Blood contains iron - which is responsible for creating hemoglobin - a protein that aids the red blood cells to reach oxygen to the tissues. When you bleed excessively, your body tries to make up the lost red blood cells by using the stored iron to produce more hemoglobin leading to anemia.

This anemia induced by heavy menstrual bleeding causes symptoms like weakness, breathlessness, pale skin, and mild chest pain. Even though diet can result in iron deficiency, the condition is aggravated by heavy bleeding.

  • Severe pain - A prolonged and heavy period is also associated with dysmenorrhea - the condition that causes painful abdominal cramps during menstruation. This pain can be powerful enough to prompt medical attention.
  • Infertility - Some of the illnesses that trigger a heavy period causes infertility or the inability to have a healthy pregnancy as well.

Extreme scenarios of heavy menstrual bleeding cause hypotension and even death if no prompt care is received.

Diagnosis

The diagnosis of heavy menstrual bleeding starts with the doctor asking you about your medical history, past and current menstrual cycle, and sexual activity.

Using a period tracker app or keeping a diary of the menstrual symptoms, such as the heaviness of the flow and the number of pads used, can help make the diagnosis easier.

Tests that the doctor usually performs to eliminate possible reason for heavy bleeding in periods include:

  • Blood tests - The doctor will take a sample of your blood to check for disorders like thyroid, anemia, or inherited bleeding disease.
  • A pap smear - This will collect and evaluate the cells present in your cervix for inflammation, infection, dysplasia, or cancerous growths.
  • Endometrial biopsy - In this, the pathologist closely examines the uterus lining for cellular disorders and cancer cells.
  • Ultrasound - Here, sound waves produce images of the vital female organs - uterus, ovaries, and pelvis to help the doctor find any abnormalities such as fibroids and polyps in them.
  • Sonohysterogram - This exam involves the injection of fluid into the uterus through a tube. Then, the doctor uses ultrasound to closely evaluate the uterine lining and determine the cause of heavy menstrual bleeding.
  • Hysteroscopy - Here, a thin instrument with a camera is inserted through the cervix to examine the inside of the uterus.

Treatment Measures

The mode of treatment will be chosen after considering the age and existing health of the woman, the cause and extent of heavy menstrual bleeding, and her personal preferences.

Usually, the doctor likes to start with prescribing medicines and monitoring the patient’s condition changes.

Medication

  • As a temporary solution, nonsteroidal anti-inflammatory drugs like ibuprofen can help to quickly reduce bleeding and relieve painful cramps by lowering the levels of prostaglandin.
  • Birth control pills and patches can be effective in controlling heavy bleeding, which is caused by conditions like PCOS, endometriosis, and fibroids. They can help to regulate your menstrual cycles and lighten the flow.
  • Hormone therapy includes taking progesterone pills like norethisterone to help increase progesterone levels and establish a balance of hormones to decrease heavy bleeding. However, this is a less effective method with greater risks to your health.
  • Hormonal IUD- In this long-acting treatment, an intrauterine device slowly releases levonorgestrel - a type of progestin. Studies show that bleeding becomes light or almost wholly stops within three to six months of using this.
  • Gonadotropin-releasing hormone agonists and antagonists are occasionally recommended to reduce the size of the uterine fibroids. However, the fibroids tend to return to their initial size within a few months of stopping this medicine.

Surgery

In rare scenarios, when medical therapy fails to bring about any positive results, you can consider surgical options like:

  • Endometrial ablation/ resection - These procedures destroy the lining of the uterus through the application of a laser, radiofrequency or electrosurgical wire loop. As a result, women no longer have heavy menstrual bleeding, and in some cases, uterine bleeding completely ceases. Chances of pregnancy become extremely unlikely, but you should continue to use permanent contraceptive measures till menopause or get sterilized because pregnancy after endometrial ablation has endless complications.
  • Dilation and curettage (D&C) - Here, the doctor will dilate your cervix to scrape tissues from the lining of your womb and successfully decrease the intensity of menstrual bleeding. However, recurrent D&C procedures are usually needed to ensure that the condition doesn’t worsen again.
  • Myomectomy - Myomectomy surgically removes the uterine fibroids. This surgery can be conducted either by open abdominal surgery or through the vagina and cervix. The surgeon will make the final call regarding the method after analyzing the fibroids’ number, size, and location.
  • Uterine Artery Embolization - This procedure is recommended for women whose heavy menstrual bleeding is caused by uterine fibroids. Here, the blood vessels in the uterus are injected with material to restrict the blood flow to the growths and shrink them in size. A more advanced version of the embolization would be focused ultrasound surgery which aims to shrink the fibroid growth using ultrasound waves without any incision.
  • Hysterectomy- This is a surgery to get rid of your uterus and cervix permanently. It induces sterilization and puts an end to your periods. This may be an option if you fail to control the heavy bleeding or when the cause of bleeding can’t be found and treated. More than thirty percent of all hysterectomies are performed to help with heavy menstrual bleeding.

Natural/Home Remedies/Lifestyle Changes Advised

Controlling our hormones can sometimes feel like trying to control the fault in our stars! However, we would urge you not to give up. With a doctor’s consultation and a few at-home measures you can function better and even get back your regular flow. Here are a few steps for you to consider:

Choose the correct pad -
When you are experiencing heavy menstrual bleeding, you need a heavy period pad that reassures you of reliable absorbency and maximum comfort. Women who have heavy periods often mistakenly select a pad meant for regular flow. Using multiple sanitary pads can lead to a highly messy and inconvenient affair.
This is why you should make the switch to the RIO heavy flow pad - the best pads for heavy periods. The extra-long and curved RIO pads are specially designed with the deeply-absorbent antibacterial SAP technology to ensure that your hygiene levels are maintained even on the heaviest of flows.
RIO Heavy Flow pads also have a soft cottony outer layer free of chemicals, which serves as a perfect solution to India’s humid weather, which makes your skin more prone to itchiness and rashes. It comes with side leg guards and wide back wings that offer complete protection from sudden leakage even as you move around.
Hydration -
If you experience heavy menstrual bleeding, keep an eye on your hydration levels. It’s necessary to drink at least eight to ten glasses of water in the day to ensure that you are adequately hydrated and reduce abdominal cramps.
Eat a Balanced Diet -
A study done by Oxford University researchers showed that the immune system is compromised in its fighting abilities during menstruation due to a drop in estrogen levels. Thus, a balanced diet during your heavy periods can provide your body with the strength to get through the harsh experience. Eat fresh fruits and vegetables filled with all the minerals and vitamins, especially Vitamin C, since it aids your body in absorbing iron. The foods that contain Vitamin C are:
  • Broccoli
  • Grapefruits, orange, kiwis, and strawberries
  • Brussels Sprouts
  • Red and green bell peppers

Iron-rich foods - Heavy flow days might leave you feeling very weak and tired due to the significant amount of blood and iron loss. Here are some iron-rich foods that you must include in your daily diet to increase your iron intake and prevent anemia:

  • Apples
  • Spinach
  • Eggs
  • Milk
  • Beans
  • Shellfish
  • Chicken
  • Tofu
  • Quinoa
  • Dark Chocolate
  • Pumpkin Seeds

Cut down on alcohol and caffeinated drinks like tea and coffee since they absorb a significant amount of iron from your body. In addition to that, stay away from processed foods, sugary foods, and starchy carbs that can increase your heavy bleeding symptoms.

Another simple way to raise your iron levels is by cooking your meals in a cast-iron pot. However, if you find that your iron deficiency is too advanced to be remedied by only dietary changes, consult your primary doctor to get iron supplement pills.

    • Take care of your mental health - Most women find themselves emotionally overwhelmed and easily irritated due to mood swings triggered by hormonal changes on periods. And, the additional stress of heavy bleeding can be challenging to deal with. It will be a good idea to focus on your self-care, spend time on activities that make you feel happy and relaxed. Talk to your close friends and family who can understand what you are going through. You can even seek help from a mental health professional like a psychologist or therapist.
    • Prioritize your hygiene - To prevent vaginal infections and rashes during heavy flows, use lukewarm water and mild soap to keep yourself clean down there. Say a complete no to extravagant “sensitive care products” with unreal claims.
    • Exercise - Avoid skipping your exercise, workout, and yoga routines, even on heavy periods. Staying physically active can significantly alleviate the pain and stress during this time.

Lastly, get as much sleep as possible to beat the fatigue and assist your body in restoring the blood and improving your overall well-being.

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