In a normal menstrual cycle, a woman loses an average of two to three tablespoons (35 to 40 milliliters) of blood over three to seven days. However, some women lose a lot more blood. Menorrhagia is the medical term for heavy or prolonged menstrual bleeding which occurs repetitively and the blood loss interferes with ones quality of life, such as interfering with normal activities like going out, working or shopping. Women who lose more than six tablespoons (about 80 milliliters) of blood during their menstrual period are said to have menorrhagia.

Menorrhagia can occur alone or in combination with other symptoms. Most women have a menstrual period every 25 to 35 days with the average being every 28 days.

Losing a lot of blood during the menstrual period can cause medical problems like anemia (low number of red blood cells).

The most common causes of excessive menstrual bleeding include; not ovulating every month, having abnormal growths in the uterus, such as polyps (small, growths in the inner surface of the uterus) or fibroids, overgrowth of the lining of the uterus (called endometrial hyperplasia, which can finally lead to development of uterine cancer), and having a medical condition which increases bleeding throughout the body, such as low blood platelets levels, taking blood thinning medications for treatment of blood clots such as warfarin.

Women who suffer from menorrhagia usually deal with soaking through a pad or tampon every one or three hours on the heaviest days of the period, bleeding for more than seven days, and, need to use both pads and tampons at the same time due to heavy bleeding. They also need to change pads or tampons during the night, pass blood clots larger than one inch, and show symptoms of iron deficiency anemia and general body weakness, fatigue, dizziness, and etcetera.

The specific cause of one’s heavy period can be diagnosed by taking proper history of the patient’s complaints, doing a physical examination, and specific investigations are further done to confirm the diagnosis. Blood tests can be done to look out for a bleeding disorder, anemia, or thyroid disease. An ultrasound can detect endometrial polyps and fibroids. A small piece of the tissue inside of the uterus, called an endometrial biopsy can be taken off and sample taken for laboratory analysis. A thin flexible tube attached to a camera end that allows the doctor to look inside one’s uterus in order to diagnose and treat causes of abnormal bleeding can be done, called hysteroscopy. 

The best treatment of heavy menstrual bleeding depends on a number of factors such as; the cause of ones bleeding, patient’s preferences, the need to prevent pregnancy, and ones desire to have children in the future.

There are medicines which are helpful in reducing the amount of menstrual flow and in case of any associated severe pain. For conditions such as fibroids and uterine polyps, surgery can be done and this might reduce the amount of subsequent menstrual flow greatly. For some women with severe symptoms and who don’t wish to have children anymore, surgery to remove or destroy the lining of the uterus (called endometrial ablation) or surgery to remove the whole uterus (called hysterectomy) can be the treatment of choice to overcome the bothersome symptoms.

It is, however, important to know that not all women with heavy bleeding need treatment but only those whose symptoms interfere with their daily life activities or who present with features due to loss of blood. Iron supplement tablets can be of importance in helping to replace the lost iron during the flow to prevent development of anemia.

Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospital.