Abnormally heavy or prolonged menstrual bleeding is also called ‘abnormal uterine bleeding’. It can be scanty, delayed or prolonged bleeding. We sometimes use this general term to describe bleeding that does not follow a normal pattern, such as spotting between periods. It used to be referred to as menorrhagia, but this term is no longer used medically.
On average, a typical woman passes around 40 ml of blood during her menstrual period, which lasts around four to seven days. For some women, however, bleeding may be excessively heavy or go on for longer than normal.
A woman may have ‘chronic’ heavy or prolonged bleeding (for more than six months) or it may be ‘acute’ (sudden and severe). In most cases, the causes of abnormal menstrual bleeding are unknown. See your Gynecologist about any abnormal menstrual bleeding.
Symptoms of abnormal periods
Symptoms include:
- bleeding for more than eight days
- heavy blood loss during the menstrual period – for example, soaking through one or more sanitary pads or tampons every hour for several hours in a row
- needing to change your pad or tampon during the night
- have to change or restrict your daily activities due to your heavy bleeding
- bleeding or spotting between periods (intermenstrual bleeding)
- cramping and pain in the lower abdomen
- fatigue
- any vaginal bleeding after menopause.
Causes of abnormal periods
While in many cases it is not possible to determine the exact cause, there are a number of reasons a woman may experience abnormal uterine bleeding. Some of the known causes of abnormal uterine bleeding include:
- spontaneous miscarriage in pregnancy
- Ectopic pregnancy – lodgement of the fertilised egg in the slender fallopian tube instead of the uterine lining
- hormonal disorders – conditions such as hypothyroidism (low levels of thyroxine), polycystic ovarian syndrome (PCOS) and hyperprolactinemia can disrupt the menstrual cycle
- ovulatory dysfunction – this is when the ovary does not release an egg each month. Most commonly, this occurs at either end of a woman’s reproductive years, either during puberty or at menopause
- Endometriosis – the cells lining the uterus (endometrial cells) can travel to, attach and grow elsewhere in the body, most commonly within the peritoneal cavity (including on the outside of the uterus or on the ovarian surface)
- infection – including Chlamydia or pelvic inflammatory disease
- medication – may include anticoagulants, which hinder the clotting ability of the blood; phenothiazides, which are antipsychotic tranquilisers; and tricyclic antidepressants, which affect serotonin uptake
- Intrauterine device ( IUD) – is a contraceptive device that acts as a foreign body inside the uterus and prompts heavier periods
- hormonal contraceptives – may include the combined oral contraceptive pill, injections of a long-acting synthetic progesterone, a rod containing slow-release progesterone (implanted in the upper arm), or intrauterine system devices (progesterone-releasing contraceptive devices inserted into the uterus). The progesterone-only treatments commonly cause spotting
- hormone replacement therapy – used as a treatment for menopausal symptoms
- Fibroids – benign tumours that develop inside the uterus
- Polyps – small, stalk-like projections that grow out of the uterus lining (endometrium). Polyps may be associated with fibroids
- bleeding disorders – may include leukemia and von Willebrand disease
- cancer – most uterine cancers develop in the lining of the uterus, though some cancers grow in the muscle layers of the uterus. They are most common after menopause.
Diagnosis of abnormal periods
The diagnosis and identification of potential causes of abnormal uterine bleeding involves a number of tests including:
- general examination
- medical history
- menstrual history
- physical examination
- Cervical screening test
- blood tests
- vaginal ultrasound
- endometrial biopsy.
Dr. Ruchi Tandon is a Gynecologist, practicing in leading hospitals in South Delhi, namely, max panscheel, max smart superspeciality hospital saket, Apollo hospitals, Delhi. She has over 13 years of clinical experience in handling abnormal periods.