Reasons of excessive vaginal bleed or heavy periods(Menorrhagia)

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What is menorrhagia?

Menorrhagia means heavy periods or excessive vaginal bleeding during menstruation or menses. Female can bleed like a flooding and may pass blood or clots or can bleed for more than seven days. It is a very common condition and affects 5-10% of women.

What are the symptoms?

Heavy bleeding during periods or between periods.

Cramping pain in the lower abdomen.

Due to loss of excess blood, symptoms of anemia can appear like fatigue, shortness of breath and tiredness.

What is the cause of menorrhagia?

Most of the cases are due to hormonal changes. Other common causes are fibroid, endometriosis, miscarriage, ectopic pregnancy, infection, hormonal contraceptives and rarely cancer.

How is it diagnosed?

Menorrhagia is diagnosed after vagina examination and few tests like cervical screening test, infection screening swabs, ultrasound and if required endometrial biopsy.

What is the treatment?

Treatment is directed towards the cause. If there is any fibroid, it should be removed. Similarly, if there is any infection, it should be treated.

In cases when there is no obvious underlying cause, it is likely due to hormonal changes. Some treatment options are combined hormonal contraceptives, progesterone tablets, tranexamic acid tablets and intrauterine devices like Mirena. Take regular iron supplements and avoid aspirin to prevent excess bleeding.

Dr Sadaf Sarwar
MBBS (King Edward Medical College),
Fellow Royal Australian College of General Practitioner (FRACGP, Australia)

Ex-Assistant Professor, The University of Lahore, Pakistan
Consultant General and Family Physician

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