The Science of Women

Heavy and Irregular Menstruation

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The normal menstruation cycle ranges from 21 days to 40 days. There may be some mild cramps, that is not persistent, on the first day. Menstruation should end within a week and there should not be any large blood clots. A woman’s menstruation cycle starts around age 10 and ends at menopause around age 51.


What are the common causes?

A very common cause if Dysfunctional Uterine Bleeding (DUB) arising from hormonal fluctuation associate with dysfunctional ovulation. The other causes of heavy and irregular menstruation can be classified using the PALM-COEIN classification below.




When is menstruation heavy and irregular?

Menstruation is considered abnormal when :-
❖ Bleeding exceeds a week, comes with clots and overflows your pad
❖ Bleeding occurs every week or two without stopping
❖ Bleeding is associated with fainting spells, severe tiredness and drop in blood count.
❖ The Picture Bleeding Assessment Chart exceeds 100 points/day.



It will be good to chart your menstrual pattern and blood loss with the Picture Bleeding Assessment Chart.

Download the Picture Bleeding Assessment Chart PDF


What do I need to do?

You should see a gynaecologist if heavy or irregular menstruation persists for more than 2 months.
A detailed specialist review, physical examination and ultrasound will usually elicit the cause.
A biopsy of the menstruation lining (endometrium) may be needed to formulate an appropriate management.
A minor surgery called Hysteroscopy may be needed to look for and remove polyps/fibroids.


Hysteroscopy and Endometrial Biopsy (Dilatation Curettage)


What are my treatment options?

❖ Medication both hormonal or non-hormonal can reduce heavy and irregular menstruation.
❖ Mirena Intrauterine Device.
❖ Hysteroscopic surgery to remove endometrial polyps, submucosal fibroids and/or the menstruation lining.
❖ Surgery to remove the womb, preferably by Single Incision Laparoscopic Keyhole Surgery.