Heavy and Irregular Menstruation
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.
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.