Abnormal menstrual bleeding

What is considered abnormal menstrual bleeding?

Increased menstrual bleeding is abnormal. This is a fairly common condition and one in five women suffers from increased menstrual bleeding. This condition can be accompanied by symptoms of prolonged and unstoppable bleeding, sometimes passing tissue parts and blood clots, which require frequent replacement of pads and tampons.

Significant and prolonged loss of blood will cause fatigue and weakness due to anemia (iron deficiency). Excessive bleeding may cause pain and discomfort, caused by embarrassing situations.

According to the literature, 60 to 80 millilitres of blood or more during menstruation would be considered as increased bleeding. About 90% of women will lose only about 30-40 millilitres of blood during menstruation. Increased bleeding requires more frequent replacement of sanitary products and for some, it would even run through pads/tampons and clothing. Bleeding that requires simultaneous use of both tampons and pads to prevent leakage is usually increased menstrual bleeding.

At a young age, this condition can be caused by ovulation disorder or bleeding disorders. The most common cause in women in their fifth decade of life, in pre-menopause, is hormonal imbalance. Also, non-cancerous uterine conditions such as polyps, fibroids, adenomyosis, infection or chronic diseases can cause severe menstrual bleeding at any age.

Possible treatments for Abnormal menstrual bleeding

Medications

Hormones to restore hormonal balance. This treatment is acceptable in women who wish to remain fertile, and effective in reducing bleeding, without the need for surgery.

Mirena IUD

An intrauterine device containing a slow release progesterone. The Mirena was initially marketed as a contraception device, but over the years it has proven to be a very effective in reducing bleeding, and is now accepted as a first line treatment for women with increased bleeding at all ages. Following the introduction of Mirna for the treatment of bleeding, the number of uterine hysterectomys worldwide, declined. Mirna is effective for 5 years, or in its smaller form, JANESS, for teenagers, for 3 years (not yet in Australia). Mirana does not reduce bleeding immediately, but gradually within a few months. Therefore, Mirna is not suitable for women with particularly severe bleeding, unless given in combination with hormone therapy in the first few months.

D&C (CURETTAGE)

was accepted as the first surgical treatment for women who did not respond to medication. This treatment involves mechanical removal of the endometrium under general anesthesia, thereby reducing bleeding, and is still used in cases of severe bleeding that require immediate treatment until definitive treatment is given.

Endometrial ablation

a treatment suitable only for women who have completed their birth plans and have an anatomically normal uterine cavity. The treatment is not used as a contraception and therefore contraceptives should be used. There are a few techniques of Endometrial ablation in the market, which are all effective with high success rates. In most cases, menstrual bleeding disappears or is significantly decreased. Most women return to normal activity after a couple of days.

Hysterectomy

It is recommended only after trial and failure of other methods to reduce bleeding, as detailed above. Removal of the uterus by surgery, as open abdominal surgery or laparoscopic, is done under general anesthesia, requires hospitalization for several days, recovery time of several weeks at home and has the risk of possible copmlications.

With saying that, this is the definitive solution for some women, that might restore their life quality.

Consult with Dr Michal Amir about the different treatment options, and together we will choose the right one for you.

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