Your period is longer than usual. You are staining all your clothes. You feel faint all the time. Gwen Lee of HealthAnswers finds out what causes excessive bleeding and how you can stop it.
Julie Charles*, 36, was late for work but was desperate not to get up from her seat on the train until she reached the last stop. She was afraid people would see the bloody stain on her seat. She was breathless, and giddy. When she consulted a doctor, he found her haemoglobin level at a low of 10 g%.
Karen James*, 41, was barely conscious when she was rushed to the hospital. A housewife with three children, she has been menstruating non-stop for 15 days. And her medical records showed she was left with a haemoglobin level of 5.7g%, half of that of an average woman.
What is menorrhagia?
Excessive menstrual bleeding or menorrhagia afflicts one in every five women worldwide, according to estimates by the World Health Organisation.
Menorrhagia is defined as abnormally heavy menstrual periods in which blood loss of more than 80 mls occurs during one menstrual period. Given that blood loss for a normal period is only around 5 mls, women suffering from menorrhagia may be bleeding 10 to 20 times more each month, which if untreated, will adversely affect their health in the long run.
According to a Healthanswers consultant obstetrician & gynaecologist in private practice, if a woman has to use 8 to 10 sanitary pads or tampons a day - which is equivalent to changing a pad or tampon every two hours - and bleeding more than 7 days routinely, she is considered menorrhagic.
In addition, she says that women with menorrhagia often pass clots of blood and experience 'flooding'- sudden, heavy loss of blood.
"For some women, the moment they stand up, blood would start to pour and soak through their tampon and underwear to trickle down their legs. Others can't even get up to go to work for one or two days because their flow is too heavy; once they sit down, they'd stain their skirt, they have to lie down and rest."
How Heavy Periods Come About
The lining of a woman's uterus or endometrium will prepare itself for pregnancy every month by filling itself with blood and fluid to make it thicker. But if there is no fertilized ovum to grow into a baby on the endometrium, the thickened lining will leave the uterus through the vagina, causing a menstrual period. But this normal menstrual flow can turn into a downpour for many reasons.
The most common cause of excessive uterine bleeding among local women is hormonal imbalance.
When ovarian hormones like oestrogen and progestogen go out of control, blood vessels buried in the uterine lining do not contract as they bleed, thus they pour blood continuously. These blood vessels may also be excessively activated. Also, some menorrhagic women tend to have thicker endometrium with more blood vessels buried beneath it or lining which are delicate that bleeds more easily.
Structural Problems With The Uterus
On the other hand, menorrhagia may also be due to structural abnormality in the uterus such as the presence of benign polyps. These are small, harmless growths that look like grapes in the neck of the uterus or the lining of the uterus.
Spherical non-cancerous growths of fibrous tissue in the uterine lining, known as fibroids, can also cause excessive uterine bleeding for many reasons. Firstly, the presence of these fibroids in the lining would increase the surface area for menses. Secondly, large fibroids tend to be fed by very active blood vessels, and when these vessels bleed, it would result in a strong flow. Thirdly, the uterus may treat the fibroid as a foreign body and tries to get rid of it, causing more bleeding accompanied by painful cramps.
Are You At Risk?
Any woman between 35 to 50 years old, single or married, could be the likely target of menorrhagia.
And it can badly affect the woman's every day life; trying to manage the blood flow without embarrassing incidents creates so much stress that she can become fearful of her periods.
Above all, excessive bleeding is detrimental to a woman's health. It is estimated that two-thirds of menorrhagic women lose so much blood each month that they suffer from iron-deficiency anaemia. Sufferers of chronic anaemia may experience symptoms like tiredness, lethargy and breathlessness.
Given the haemoglobin level for a normal person ranges from 11.5g% to 16 g% and an average woman usually measure between 12g% to 13g%, if a woman's haemoglobin level is about 10g%, she's anaemic.
"If it drops to about 5 g%, it means the woman has only half the capacity to carry oxygen. As a result, her heart has to pump twice as hard for the body to get enough oxygen. This in turn tires the heart muscle and in extreme cases, it may go into heart failure and the woman may collapse in shock, or even lose her life.
Treatments For Excessive Bleeding
The latest additions to the list are two outpatient procedures that treat the endometrial lining, namely the Uterine Balloon Therapy and the Microwave Endometrial Ablation.
They are based on the principle that since bleeding comes from the endometrium, by removing this lining that is usually 4 mm thick, one can stop the excessive bleeding altogether.
|Uterine Balloon Therapy (ThermaChoice)
During the procedure, a soft, flexible balloon attached to a thin catheter is inserted into the vagina through the cervix and placed into the uterus. Then the balloon is inflated and filled with a sterile fluid. The fluid in the balloon is heated to 87 degrees Celsius and this temperature is maintained for about eight minutes, during which thermal ablation of the uterine lining takes place. After treatment, the fluid, balloon and the catheter are all removed.
While the fluid-filled balloon is in the uterus to 'burn' the uterine lining, patients may experience some crampy pain that may last for a few hours. However this can be treated by painkillers. The pain occurs because the uterus tend to react to the balloon as it would to any foreign body.
Over the next 7 to 10 days after treatment, the uterine lining will slough off like a period.
|Source: Johnson & Johnson |
To be a candidate for this procedure, the woman's uterus must not be too large and must have a regular-shaped cavity to hold the shape of the balloon,otherwise the balloon won't be able to burn every part of the uterine lining. So before the procedure, doctors must first rule out the presence of any polyps or fibroids in the uterus.
Microwave Endometrial Ablation (MEA)
MEA uses high frequency microwave energy to cause rapid but shallow heating of the endometrium to destroy it.
The microwaves are delivered by means of an applicator that is gently inserted into the uterus via the cervix. Once the applicator tip reaches the top internal part of the uterus, power is applied to it. As the internal temperature of the uterine lining reaches therapeutic level, the applicator is moved from side to side to cover the entire uterine cavity lining. The applicator is then withdrawn from the uterus and the procedure is over.
Between four and six weeks prior to the microwave treatment, patients are given hormonal tablets or jabs to thin the uterine lining because it is found that MEA 'burns' better if uterine lining area is thin, dry and not bleeding.
Just like ThermaChoice, patients who receive MEA treatment usually have a watery, blood-stained discharge for about two weeks after the procedure as the 'burnt' area heals itself.
A comparison of the two treatments can be found in the following table:
Ability To Deal
With Submucous Fibroids
|tiny, submucous fibroids|
|*Based on the result of a recent study done in the Netherlands. |
The two procedures, however, are not for women who would still want to have children, as after 'burning' is no more endometrium to support the growth of an embryo.
Also, to be a candidate for either of the procedures, uterine cancer must first be ruled out. But unlike ThermaChoice, MEA can be used in cases where small submucous fibroids are present in the uterus.
As for complications: all gynaecologists are trained to insert simple intra-uterine device in a safe manner, therefore the insertion of a balloon or MEA applicator into the uterus should not give rise to serious problems.
A woman's sex life is also not affected, as anatomically nothing is added or taken out of the uterus throughout the process.
No More Periods
If the treatments are successful, the woman will have no menses at all, or minimal bleeding for a day or so. Without the massive monthly blood loss, a woman's health generally improves and so does her everyday life.
Date reviewed: 25 July 2000