Women with heavy menstrual bleeding must be properly assessed to achieve the most effective health and treatment outcomes

Heavy menstrual bleeding (HMB) is a painful, debilitating condition that affects one in five women globally. Although fairly common, it is often misdiagnosed, leading to treatments that do not properly contain or resolve the condition. Obstetrician-gynaecologist Dr Dharshini Gopalakrishnakone from Kierauniv International Clinic for Women explains the importance of accurate diagnosis, and the ways HMB can be identified and treated.

What is heavy menstrual bleeding?

An average woman loses about 40ml of blood every menstrual cycle. Those with HMB, also known as menorrhagia, lose twice that or more. While there is no practical way to measure the exact volume of blood lost, women should see a specialist gynaecologist if they have any of these symptoms:

  1. Soaking through sanitary products every hour for several consecutive hours
  2. Needing to wake up to change sanitary products during the night
  3. Bleeding for longer than a week
  4. Passing large blood clots
  5. Having to reschedule work, social activities or school
  6. Severe, often debilitating cramps
  7. Symptoms of anaemia such as fatigue, shortness of breath, and headaches

What are the causes of HMB?

Gynaecologists use a FIGO (The International Federation of Gynecology and Obstetrics) classification system called PALM-COEIN to distinguish between the causes of HMB. This acronym stands for:

  1. Polyps (Uterine): An abnormal growth of tissue from the mucous membrane of the uterus.
  2. Adenomyosis: A condition in which the lining of the uterus (endometrium) breaks through the muscle wall of the uterus.
  3. Leiomyoma (Uterine): Known as fibroids, which are benign smooth muscle tumours.
  4. Malignancy and hyperplasia: An abnormal increase in the number of cells in an organ or tissue before they turn cancerous. Under a microscope, these hyperplastic cells appear normal.
  5. Coagulopathy: When the blood’s clotting ability is impaired
  6. Ovulatory dysfunction: A condition in which ovulation is abnormal, irregular, or absent, leading to irregular or absent menses.
  7. Endometrial: A catch-all classification applied to HMB, intermenstrual bleeding or prolonged bleeding not obviously caused by other abnormalities in women of reproductive age who seem to have normal ovulatory function.
  8. Latrogenic: An illness or effect caused by a procedure or medications. HMB is a relatively common consequence of anticoagulant drugs including warfarin, heparin and low molecular weight heparin.
  9. Not yet classified: This category includes several uterine entities that might contribute to, or cause HMB but have yet to be adequately researched or defined. As further evidence becomes available, these known entities may be placed into an existing category in the system or allocated new ones.

For some women, HMB can also be caused by endometriosis where endometrial cells grow outside the womb. Those with close female relatives who have HMB, or have conditions that cause HMB, are also more at risk of the condition.

Obstetrician-gynaecologist Dr Dharshini Gopalakrishnakone from Kierauniv International Clinic for Women

Why is accurate diagnosis important?

Many women with HMB tend to see the doctor for their symptoms but are often misdiagnosed, resulting in treatments that do not properly contain or resolve the condition. One such patient I have been seeing in my practice is Laksmi Hapsari who has endometrial hyperplasia which I discovered through a hysteroscopy, a procedure that enabled me to examine her womb lining.

If she had not consulted me in time, her condition might have progressed to endometrial cancer. This is why it’s important for women, especially those above 40, with prolonged heavy menstruation, to consult a gynaecologist to ensure there are no serious underlying medical issues.

How is HMB treated?

In the case of Laksmi, I treated her with an intrauterine system (IUS), a treatment that reduces or even stops menstrual bleeding. The IUS controlled Laksmi’s symptoms and reversed her endometrial hyperplasia, thereby potentially preventing the development of endometrial cancer in the future. This simple treatment also preserved her fertility and prevented unnecessary surgeries, such as a hysterectomy.

Other treatments for HMB may also include oral contraceptive pills and nonsteroidal anti-inflammatory drugs, though these may have side effects including nausea, bloating, breast tenderness, and stomach problems.

My advice is always to speak to a gynaecologist about your symptoms before deciding on any treatment so that they can properly diagnose the condition and devise effective solutions according to individual needs.

#heavymenstrualbleeding #heavyperiods #periodstigma #womenshealth

Featured photo by Shutterstock
Dr Dharshini Gopalakrishnakone photo courtesy of Dr Dharshini Gopalakrishnakone.