Get Treatment For Excessive Menstrual Bleeding

If you have menstrual bleeding that is abnormally heavy and prolonged - lasting for more than a week and ending up affecting your normal activities, you may have a condition called excessive menstrual bleeding, which is medically termed as menorrhagia. Although heavy menstrual flow is common among premenopausal women, in most women, blood loss will not be as severe to be defined as menorrhagia. If you have to change your sanitary pads in less than 2 hours of wearing or you pass larger sized clots, then you tend to have heavy bleeding. This may happen for various reasons, but the most common are uterine fibroids, hormonal imbalances, and endometrial polyps. There are several effective treatments available for menorrhagia. If left untreated, abnormally heavy bleeding may lead to anemia and other associated problems such as fatigue and weakness.

Surgical Procedures Performed at Cedars-Sinai Marina del Rey Hospital for Excessive Menstrual Bleeding

Excessive menstrual bleeding may be treated with various surgical techniques, such as:

• Dilation and Curettage (D&C): In this procedure, the removal of the uppermost layer of the lining of the uterus is done to reduce menstrual blood flow. This procedure needs to be repeated over a period of time.
• Operative hysteroscopy: This involves the use of a special tool to visualize the inner portion of the uterus. During the surgical procedure, this tool will be modified and used to cut away polyps and fibroids, scrape off the uterus lining, and correct any abnormalities in the uterus.
• Endometrial ablation or resection: This procedure involves two different techniques - the removal of a part or entire lining of the uterus. In some patients, menstrual periods may stop completely, but others may have menstrual bleeding that is much scanty than before. After this procedure, though the uterus remains intact, women may not be able to conceive.
• Hysterectomy: This is a major surgical procedure performed at a hospital. It involves removal of the entire uterus. Menstrual bleeding stops completely after undergoing this surgery.

The surgical treatment options if your excessive menstrual bleeding is due to non-cancerous growths or uterine fibroids include the following:

• Uterine Artery Embolization (UAE): This is a minimally invasive procedure in which a flexible tube is inserted through your groin area to reach the arteries carrying blood to the fibroid. Tiny beads made of plastic are then injected through this tube in order to block these arteries, and thereby shrink the fibroid. The benefits of this procedure are:

• Minimal stay at the hospital
• Postoperative complications rarely occur
• Most successful if menorrhagia is due to fibroids

• Robotic Myomectomy: This is a minimally invasive procedure that requires smaller incisions. It has several advantages over the conventional laparoscopic myomectomy, such as:

• Minimal trauma and faster recovery
• Lesser pain and discomfort
• Minimal scarring
• Decreased loss of blood and risk of infection
• Shorter stay at the hospital

Drugs and Other Treatment Needed for Excessive Menstrual Bleeding

Your doctor will advise a treatment plan taking into account the cause of your abnormal bleeding and its severity as well as your age, overall health, past illnesses, and your preferences. It really depends on whether you just want to get rid of your pain or want the menstrual bleeding to be reduced, and your need to conceive a baby.

Intrauterine contraception device »

NSAIDs »

Oral contraceptive pills »

Antifibrinolytic medicines »

Desmopressin Nasal Spray »

Iron supplements »

Hormone therapy »

Symptoms of Excessive Menstrual Bleeding

The symptoms of excessive menstrual bleeding include:

• Menstrual flow lasting for more than 7 days
• The need to change your pad or a tampon for almost every hour and even in the night
• A feeling of a surge of blood once you stand
• Large sized blood clots passed along with menstrual blood
• Cramps or continuous pain in the lower part of your stomach
• Tiredness and difficulty in breathing

Diagnosis of Excessive Menstrual Bleeding

Your doctor will advise certain tests to check whether you have a bleeding disorder. The diagnostic tests include:

• Blood tests: A sample of your blood will be drawn using a needle. Then, specific tests will be done to check for conditions such as anemia, clotting problems, and thyroid disorders.
• Pap test: In this test, cells of the cervix are collected to check for the presence of features of infection, inflammation or cancer.
• Endometrial biopsy: A sample of tissue is removed from the inner lining of your uterus to check for the presence of cancerous or other abnormal cells.
• Ultrasound examination: This involves the use of painless, sound waves to create images of your blood vessels, tissues, and internal organs on a computer. This helps to check the flow of your blood and see how your organs work.

Based on the results of these initial screening tests, your doctor may recommend further tests such as:

• Sonohysterogram: In this test, a tube is passed into your uterus through your vagina and cervix. Fluid is injected to fill your uterus. Then, an ultrasound scan is done to check for problems in the uterine wall. It is common to feel a mild to moderate cramping kind of pain or pressure during this test.
• Hysteroscopy: In this procedure, the inner portion of your uterus may be viewed through the use of a thin, flexible tube with a camera at its end. It helps to rule out fibroids, polyps, or other abnormalities that may be the reason for your abnormal menstrual bleeding.
• Dilation and Curettage (D&C): This is a simple procedure that can both reveal and treat the cause of your excessive menstrual bleeding. It is done at a hospital, but you can return home on the same day. The inner wall of your uterus is scraped to examine and find out the reason for excessive bleeding during menstrual periods.

Risk Factors for Excessive Menstrual Bleeding

A hormonal imbalance is often the reason behind excessive menstrual flow or menorrhagia that is associated with menstrual cycles without the release of an ovum (anovulatory cycles). If you have a normal cycle, the ovulation occurs, which stimulates the production of the female hormone called progesterone. This is why anovulatory cycles lead to insufficient amounts of progesterone, which cause excessive menstrual bleeding. Two different age-groups are most prone to have anovulatory cycles, and these include:

• Adolescent girls after menarche: Girls who have started getting menstrual periods recently are prone to have anovulatory cycles during the first year after their first menstrual cycle.
• Older premenopausal women: Women in their 40s to 50s who are approaching menopause are prone to hormonal imbalances that lead to anovulatory cycles.

Causes of Excessive Menstrual Bleeding

The potential reasons for excessive menstrual bleeding are divided into the following categories:

• Uterine-related problems

• Non-cancerous growths or tumors of the uterus, for example uterine fibroids or polyps
• Uterine or cervical cancer
• Certain contraceptive methods—for example, an intrauterine device (IUD).
• Pregnancy-related problems such as ectopic pregnancy or miscarriage can lead to abnormal bleeding.

• Hormonal imbalances
• Other disorders

• Bleeding disorders (von Willebrand disease (VWD) or platelet function disorder)
• Disorders affecting the liver, kidney, or thyroid functions, pelvic inflammatory disease, and cancer.

Various herbal remedies have been used to treat excessive menstrual bleeding. The goals of alternative therapies for excessive menstrual bleeding do not differ from that of conventional treatments - control of bleeding, prevention and treatment of anemia, and restoration of a favorable pattern of the menstrual cycle. It is important to take the correct dose of the herbal formulations, and therefore it is recommended to consult your doctor before taking up any alternative treatments.

Herbal remedies

Chaste tree (chaste berry): This is the best ever known herb used in the treatment of abnormal bleeding and hormonal imbalances in women. It has a progesterone-like action and increases the luteinizing hormone suppressing the release of follicle stimulating hormone. It may need several months to regulate your menstrual cycle as it is not a fast-acting herb.

Ginger: Traditionally, ginger was used as an anti-inflammatory agent, and this property helps reduce the flow during heavy menstruation.

Astringent herbs: These herbs belong to a category called tannin-containing plants, which can reduce blood loss related to the reproductive tract. These are used to reduce uterine as well as cervical bleeding. Shepherd’s purse has been used since a long time in the prevention or arrest of gynecological bleeding.

Traditional herbal uterine tonics: Tonic herbs are used to improve uterine tone, which may regulate your menstrual flow. In traditional herbal medicine, ragwort or life root has been used in the management of conditions such as menorrhagia and painful menstrual cramps. The root portion of blue cohosh may be used in combination with other astringent herbs to act as a uterine tonic that reduces bleeding and regulates your menstrual cycle.

Traditional herbs to treat blood loss: Yarrow has been traditionally known for its uterine stimulant nature and its effectiveness in the treatment of menstrual disorders. The Chinese herbal formulations that help in controlling excessive menstrual bleeding include Tripterygium wilfordii Hook f, Xiao Yao San – modified, also called Rambling Powder, and Dong-quai.

Another herb called wedelia calendulacea less, which contains isoflavanoids and wedelolactone that are similar structurally to the clover estrogen coumestrol may be used to treat menorrhagia and uterine hemorrhage. Other herbs useful in menorrhagia include: bayberry bark, also called wax myrtle and black cohosh.

Acupuncture

The healthcare professionals who practice acupuncture or acupuncturists can identify specific points called “trigger points”, which are related to physiological and anatomical structures such as junctions of the peripheral nerves. These acupuncture points are thought to stimulate your central nervous system and cause the release of chemicals into your muscles, spinal cord, and brain. This leads to the release of hormones that can influence the self-regulating system of your body. Studies have shown the effectiveness of acupuncture in the treatment of excessive menstrual bleeding.

Chiropractic care

Chiropractic treatments such as spinal manipulation and soft-tissue therapy have been found to be beneficial in menstrual disorders, mainly dysmenorrhea and chronic pelvic pain and premenstrual syndrome. Further clinical studies to find out the effect of spinal manipulation on excessive menstrual bleeding are required.

Even though the exact measures that can prevent heavy menstrual bleeding are not clearly known, women with this concern are often advised on making certain changes in their daily diet. Include plenty of fibers, certain fatty acids and vitamins in your diet as this helps you manage heavy periods better. In order to prevent anemia that may result from heavy blood loss, eat food rich in iron such as green leafy vegetables, legumes, whole cereals, and meat. Try to manage your daily stress effectively.

If you need any information or guidance regarding excessive menstrual bleeding, consult our highly knowledgeable gynecologists at Cedars-Sinai Marina del Rey Hospital.