How to understand that blood loss is excessive
It is impossible to accurately measure blood volume in everyday life, so they focus on practical signs. It is alarming if menstruation lasts longer than seven days, hygiene products have to be changed more often than once every two hours for several hours in a row, clots larger than two and a half centimeters appear, you need to use a pad and a tampon at the same time, or get up at night. An important indirect sign is the need to plan things around menstruation. Additionally, chronic blood loss is indicated by low hemoglobin and ferritin in tests, as well as weakness and hair loss.
- Menstruation longer than 7 days
- Change the gasket more than once every 2 hours
- Clots larger than 2.5 cm
- Getting up at night to change hygiene products
- Limiting normal activity on these days
- Low hemoglobin and ferritin
Causes from the uterus
The most common structural causes are fibroids, especially nodes growing towards the uterine cavity, endometrial polyps and adenomyosis, in which endometrial tissue grows into the muscle layer. Heavy menstruation occurs with endometrial hyperplasia, chronic endometritis, and also after installation of a conventional copper intrauterine device. In older women, precancerous changes and endometrial cancer are always excluded, especially with bleeding between menstruation. That is why heavy menstruation requires not the selection of hemostatic agents, but a search for the cause.
- Uterine fibroids
- Endometrial polyps
- Adenomyosis
- Endometrial hyperplasia
- Chronic endometritis
- Copper intrauterine device
- Precancerous changes and endometrial cancer
Common Causes: Blood and Hormones
Approximately some women with heavy menstruation have blood clotting disorders, most often von Willebrand disease. Anamnesis helps to suspect them: heavy menstruation from the very first cycle, frequent nosebleeds, bruises from minor blows, prolonged bleeding after tooth extraction or childbirth, similar problems in relatives. Blood loss is increased by taking anticoagulants and drugs that affect platelets. Among the hormonal causes, hypothyroidism, polycystic ovary syndrome and anovulatory cycles in adolescence and perimenopause are significant.
- Von Willebrand's disease and other clotting disorders
- Taking anticoagulants and antiplatelet agents
- Hypothyroidism
- Polycystic ovary syndrome
- Anovulatory cycles in adolescents and perimenopause
- Liver diseases
Survey
The doctor clarifies the nature of menstruation, its duration and impact on life, the history of bleeding and medications taken, then conducts an examination. A complete blood count and ferritin show whether there is anemia and iron deficiency. Pelvic ultrasound reveals fibroids, polyps, adenomyosis and endometrial thickening. If pathology of the uterine cavity is suspected, hysteroscopy is performed, during which the polyp can be immediately removed, and an endometrial biopsy. Be sure to check TSH, and if there are signs of increased bleeding, a coagulogram and examination by a hematologist. In women of reproductive age, pregnancy is excluded.
- Examination by a gynecologist
- Complete blood count and ferritin
- Ultrasound of the pelvic organs
- TSH
- Coagulogram for bleeding tendency
- Hysteroscopy and endometrial biopsy
- Pregnancy test
Treatment
The choice depends on the cause, age, severity of anemia and plans for pregnancy. Among the medications used are non-steroidal anti-inflammatory drugs during menstruation, drugs that reduce blood loss due to their effect on coagulation, combined hormonal contraceptives and progestogens. One of the most effective methods is an intrauterine system with a hormone, which significantly reduces the amount of blood loss. Polyps and submucosal nodes are removed during hysteroscopy; for fibroids, myomectomy or embolization of the uterine arteries is possible. Removal of the uterus is considered a last resort. At the same time, iron deficiency must be treated.
- Non-steroidal anti-inflammatory drugs during menstruation
- Hormonal therapy as prescribed by a doctor
- Intrauterine system with hormone
- Hysteroscopic removal of polyps and nodes
- Myomectomy or uterine artery embolization
- Iron supplements for anemia
- Hysterectomy only if other methods are ineffective
