Menorrhagia, also known as prolonged bleeding or heavy menstrual periods, varies for each woman, so it may be difficult to tell what’s normal and what’s abnormal bleeding. Doctors say that normal menstrual bleeding is a period that lasts from three to seven days; while prolonged menstrual bleeding is defined as bleeding that goes beyond a week. Dr Kenneth Ruzindana , a consultant at Kigali University Teaching Hospital (CHUK), says that heavy menstrual bleeding is defined as excessive menstrual blood which interferes with a woman’s physical, social, emotional or material quality of life, in most cases it can occur alone or in combination with other symptoms. He adds that menorrhagia is very common, about one third of women can have this problem, it is not normal as it might destruct one’s life and could be a sign of more serious health problems. “Menstrual bleeding is considered to be heavy when the bleeding lasts for more than seven days, bleeding that soaks through one or more tampons or pads every hour for several hours in a row, if a woman needs to change more than one pad at a time, or change pads and tampons during the night or menstrual flow with blood clots that are big, then she is suffering from menorrhagia,” Ruzindana notes. SIGNS AND SYMPTOMS According to Dr Iba Mayele, an obstetrician gynaecologist at Clinic Galien, Kimironko, symptoms and signs of menorrhagia may conclude waking up to change sanitary protection during the night. Bleeding longer than eight days, bleeding outside the usual menstrual cycle, passing large blood clots, having back and abdominal pain during menstruation, feeling tired, weak, or short of breath, are signs that the excessive bleeding has reduced the amount of iron in the blood, he says. CAUSES Ruzindana explains that many factors can cause menorrhagia depending on the age of a woman, in many cases, it is usually associated with uterine fibroids or polyps (this is the extra piece of tissue that grows inside your body), and irregular ovulation, if you don’t ovulate regularly, the areas of the endometrium (the lining of the uterus) can become too thick, and this condition is very common during puberty and perimenopause (this is a part of a woman’s transition into menopause). Mayele states that hormone imbalance in a normal menstrual cycle, a balance between the hormone oestrogen, can cause abnormal bleeding. Oestrogen is is a female sex hormone that has many roles in the body, like controlling puberty and strengthening bones, and progesterone regulates the build-up of the lining of the uterus. He adds that because of the heavy blood loss, women with menorrhagia are susceptible to anaemia and may need treatment for that disorder as well. Menorrhagia also occurs in women with certain medical conditions, such as polycystic ovary syndrome (this is a hormonal disorder common among women of reproductive age) and hypothyroidism which is an underactive thyroid gland, Ruzindana notes. He adds that some women have bleeding disorders, this is when the blood does not clot properly, and it can cause heavy bleeding. Some medications like blood thinners can also cause menorrhagia. Ruzindana says, “The copper intra-uterine device that is used for contraception, which is placed in the uterus, can also cause heavier menstrual bleeding than normal, especially during the first year of use, in older women, especially in post menopause women; we worry about cancer. Menorrhagia can be an early sign of endometrial cancer, it is often diagnosed at an early stage when treatment is usually most effective.” He further says that if a woman of child-bearing age consults doctors due to heavy menses, doctors need to rule out pregnancy first, because the bleeding could be related to pregnancy and ectopic pregnancy (when the pregnancy is outside the uterus) or if she has a miscarriage. Endometriosis can also cause heavy menses. In addition, adenomyosis can also cause heavy bleeding; this is a condition where cells from the uterus lining grow into the uterus muscle. Pregnancy complications and an unusual location of the placenta, such as low lying placenta or praevia, can be a cause of menorrhagia. TREATMENT Ruzindana informs that women, especially those of child-bearing age, should discuss all their options with their doctors before making any decisions about how to manage or treat heavy menstrual bleeding. He says that the treatment depends on the cause; specific treatment is based on the number of factors which could include overall health and medical history, for instance, the capacity of a patient to tolerate some specific medication or therapies and most importantly, the patient’s preferences when it comes to child-bearing plans. “Some of the medication given includes; tranexamic acid; this helps to reduce excessive blood loss, oral contraceptives known as combined oral contraceptive pills, these help regulate menstrual cycles and reduce the episodes of prolonged and excessive bleeding. “Mirena intrauterine devices reduce the menstrual flow and cramping, if menorrhagia has caused anaemia, we recommend that you take iron supplements,” Ruzindana advises. He says that there are other procedures which may be done if medical therapies are not effective, for example; dilation and curettage (this is a surgery used to diagnose and treat conditions of the uterus). Myomectomy can also be done; this is an operation to remove fibroids while preserving the uterus. Ruzindana adds that other medications that can reduce on the bleeding, include, ibuprofen, non-steroid anti-inflammatory drugs (NSAIDs), among other treatment. editorial@newtimes.co.rw
