Menstruation, also known as periods, is an important biological process for women of reproductive age.
Bleeding patterns during menstruation vary from person to person. However, excessive or prolonged bleeding can be disruptive and concerning.
Prolonged menstrual bleeding or Menorrhagia is defined as menstrual flow lasting longer than seven days. It is also referred to as heavy periods.
In this article, we discuss the reasons, diagnosis, and treatment options for Menorrhagia.
Symptoms of Prolonged Menstrual Bleeding
Prolonged bleeding is very similar to normal menstrual bleeding, but there are certain factors, such as flow or duration, that help us differentiate the two.
- Bleeding that lasts for more than a week during your menstrual cycle
- Bleeding heavily enough to soak through one or more tampons or pads every hour consecutively
- Needing to change menstrual products frequently throughout the night
- Experiencing blood clots larger than a quarter
- Feeling fatigued or weak due to blood loss
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Causes of Prolonged Menstrual Bleeding
A study by the World Health Organization (WHO) across countries found 8-27% of women experience severe menstrual flow lasting 3 months. Several factors, as discussed below, can contribute to prolonged menstrual bleeding.
Hormonal Imbalances
Menstruation is regulated by several hormonal fluctuations that take place every month. Imbalances in these hormones, mainly Estrogen and Progesterone, can cause the uterine lining to shed in an abnormal manner, leading to heavy or prolonged bleeding.
Common conditions with hormonal imbalances include:
Perimenopause
The time period leading up to menopause, when a woman’s body starts to make the natural transition towards the end of her reproductive years, is called Perimenopause. This can disrupt hormone production and cause irregular bleeding patterns, including prolonged periods.
PCOS
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that can lead to Anovulation (absence of ovulation) and disrupt the menstrual cycle, causing prolonged or irregular bleeding.
Fibroids
Uterine Fibroids, also known as Polyps, are benign growths of tissues that can develop in or around the uterus. This can alter the uterine lining and increase menstrual bleeding.
Lifestyle factors
Your lifestyle can also disrupt your hormonal balance and lead to heavy menstrual bleeding. Factors like stress, excessive exercise, and sudden weight changes can cause hormonal fluctuations, leading to prolonged menstrual bleeding.
Other Medical Conditions
Source: Africa_imagesThere are certain medical conditions that can lead to heavy or prolonged periods. These are:
Endometriosis
This condition involves the growth of an Endometrial tissue (uterine lining) outside the uterus, which can bleed during menstruation. In some rare cases, Endometriosis after menopause can also happen.
Adenomyosis
Adenomyosis is a condition similar to Endometriosis, but here, the Endometrial tissue grows within the muscular wall of the uterus, potentially leading to heavier and longer periods.
Pelvic inflammatory disease (PID)
PID is an infection in a woman’s reproductive organs, including the fallopian tubes, uterus, and ovaries. Thus leading to irregular bleeding patterns, including prolonged periods.
Diagnosis and Treatment
Diagnosis typically involves a comprehensive history and physical examination. Additional tests might be recommended depending on your individual situation, such as:
Pelvic Ultrasound: This imaging test can visualize the uterus and ovaries, checking for fibroids, polyps, or other abnormalities.
Endometrial Biopsy: A small sample of uterine tissue is examined to rule out precancerous or cancerous changes.
Blood Tests: These can assess hormone levels or identify underlying medical conditions like clotting disorders.
Treatment for prolonged menstrual bleeding depends on the underlying cause. Here are some common approaches:
Hormonal Therapy: Oral contraceptives, progesterone-only pills, or intrauterine hormonal systems (IUS) can regulate hormones and control heavy bleeding.
Non-steroidal Anti-inflammatory Drugs (NSAIDs): These medications can help reduce menstrual blood flow and cramping.
Minimally Invasive Procedures: Techniques like endometrial ablation or uterine artery embolization can be used to destroy or block blood vessels in the uterus, reducing bleeding.
Surgery: In some cases, more extensive surgical procedures may be necessary to remove fibroids or polyps.
Conclusion
Prolonged menstrual bleeding can be a distressing experience, but it’s important to remember that it’s often treatable. PCOS, Fibroids, Endometriosis, PID, Perimenopause, stress, and weight changes, among other factors, can result in prolonged menstrual bleeding. Apart from this, lifestyle factors like weight changes, stress, and excessive exercise can lead to heavy periods.
Early diagnosis and appropriate management techniques like hormonal therapy and NSAIDs can help regulate your menstrual cycle and improve your overall quality of life.
Frequently Asked Questions
Can prolonged bleeding cause Anemia?
Yes, prolonged or heavy menstrual bleeding can lead to Anemia, especially if blood loss is significant. Some symptoms of Anemia are fatigue, weakness, and shortness of breath. Iron supplements or dietary changes can help correct iron deficiency.
How long is too long for menstrual bleeding?
Generally, menstrual bleeding lasting longer than seven days is considered prolonged. However, if your bleeding is manageable and doesn’t significantly impact your daily life, occasional variations within this timeframe might be normal.
Can pregnancy cause prolonged bleeding?
During early pregnancy, implantation bleeding can occur. This happens when an egg, after fertilization, implants itself in the uterine lining, which can sometimes mimic a light period and last for a few days. Additionally, a threatened miscarriage can cause bleeding that may seem like a prolonged period.
Can prolonged periods be normal?
In some cases, prolonged periods can be a normal variation in your menstrual cycle, especially during adolescence or Perimenopause.
Is prolonged bleeding life-threatening?
While prolonged bleeding itself isn’t life-threatening, it can be a sign of some hidden medical condition that requires treatment. Early diagnosis and treatment are important to find the root cause and prevent complications.
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