Period problems

Periods can be very heavy or prolonged and affect your daily activities.
Irregular bleeding when periods are not coming in regular intervals can cause anxiety and disturb your lifestyle.
Bleeding between the periods (intermenstrual bleeding) or after sexual intercourse (postcoital bleeding) requires investigation.

Heavy periods

Periods are classified as heavy (menorrhagia) when they cause enough blood loss and cramping that you can’t maintain your usual activities. You will notice passing clots or might need to use protection every few hours. If you have menstrual bleeding so heavy that you dread your period then you need to seek treatment. There are many effective treatments for menorrhagia.

Symptoms

• Soaking through one or more sanitary pads or tampons every 2-4 hours
• Needing to use double sanitary protection to control your menstrual flow
• Bleeding for longer than a week
• Passing blood clots
• Restricting daily activities
• Symptoms of anemia, such as tiredness, fatigue or shortness of breath

CAUSES

• Hormone imbalance. In a normal menstrual cycle, a balance between the hormones estrogen and progesterone regulates the development of the lining of the womb. If a hormone imbalance occurs, the endometrium develops in excess and causes heavy vaginal bleeding.
• Dysfunction of the ovaries. If your ovaries don’t release an egg (ovulate) during a menstrual cycle you don’t produce the hormone progesterone. This leads to hormone imbalance and sometimes to heavy periods/
• Fibroids. They are benign tumours of the uterus thatmay cause heavier than normal or prolonged menstrual bleeding.
• Polyps. Benign growths on the lining of the womb or the cervix may cause heavy or prolonged menstrual bleeding.
• Adenomyosis. This condition occurs when the lining of the womb invades the uterine muscle and often causes heavy and painful periods.
• Intrauterine device (IUD). Heavy periods are a well-known side effect of using a non-hormonal contraceptive coil.
• Pregnancy complications. Miscarriage or ectopic pregnancy.
• Cancer. Rarely, uterine cancer, ovarian cancer and cervical cancer can cause excessive menstrual bleeding.
• Medications. Certain drugs as anti-inflammatory medications and anticoagulants (eg Warfarin)
• Other medical conditions. Pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease, may be associated with menorrhagia.

Investigations

• Clinical examination
• Blood tests to evaluate for iron deficiency (anemia) and other conditions, such as thyroid
disorders or blood-clotting abnormalities.
• Smear test.
• Biopsy of the lining of the womb
• Ultrasound scan to assess the uterus, the cervix and the ovaries

Based on the results of your initial tests, your doctor may recommend further testing, including:
• Hysteroscopy. This exam involves inserting a tiny camera through your vagina and cervix into your
uterus. It can be done under local or general anaesthetic.

Medical treatment may include:

• Iron supplements
• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Tranexamic acid.
• Oral contraceptives.
• Oral progesterone
• The hormonal IUD (Mirena). This intrauterine device releases a type of progesterone called
levonorgestrel, which makes the uterine lining thin and decreases menstrual blood flow and cramping.
If you have menorrhagia from taking hormone medication, you and your doctor may be able to treat the
condition by changing or stopping your medication.

You may need surgical treatment for menorrhagia if drug therapy is unsuccessful. Treatment options include:

• Uterine artery embolization. For women whose menorrhagia is caused by fibroids. The procedure aims
to shrink the fibroids by cutting off their blood supply.
• Myomectomy. This procedure involves surgical removal of uterine fibroids. Depending on the size, and
location of the fibroids, it can be performed via open abdominal surgery, keyhole surgery, or through
the vagina and cervix.
• Endometrial ablation. The procedure destroys the lining of the womb.
• Endometrial resection. This surgical procedure uses an electrosurgical wire loop to remove the lining
of the uterus
• Hysterectomy (removal of the uterus and cervix)

Intermenstrual bleeding

This condition is defined as vaginal bleeding at any time during the menstrual cycle other than during normal menstruation. Sometimes is difficult to differentiate between intermenstrual bleeding and irregular periods.
Causes involve hormonal fluctuation, lesions of the cervix (polyps, fibroids, ectropion), lesions of the lining of the womb (fibroids, polyps), pelvic infection, precancerous changes, malignancy or medication (e.g. contraceptive pill, anticoagulants).

Diagnosis
Women experiencing inter menstrual bleeding require clinical examination by a gynaecologist and a pelvic ultrasound scan.
Blood tests can be requested and the treatment will depend on the cause of the symptoms.

Postcoital bleeding

it is non-menstrual bleeding that occurs immediately after sexual intercourse. It is usually caused by lesions of the cervix or the vagina. Those include cervical polyps, cervical ectropion, precancerous conditions or cancer and vaginal atrophy.
Every woman who notices persistent bleeding after intercourse needs to be assessed by a gynaecologist.

Heavy Menstrual Bleeding Download