Heavy Periods (Excessive Menstrual Bleeding)

Normal Amount and Duration of Period

The quantity of blood lost during the monthly periods varies among women. It is estimated to be about 20 to 60ml throughout the menstruation which can vary between 2 to 7 days but averages about 3 to 5 days in most women. Despite these difference, every woman has a fair idea of the usual amount of blood lost as a result of menstrual bleeding. Sometimes this can be excessive in which case it is known as menorrhagia – heavy vaginal bleeding or prolonged vaginal bleeding. An isolated period which is heavier or longer than normal is not a cause for concern but if it persists or is recurrent then it needs to be investigated further as it may be a symptom of some underlying disease.

Causes of a Heavy Period

Heavy menstrual bleeding is a symptom associated with various gynecological disorders, systemic diseases and with the use of certain medication. The presence of other signs and symptoms such as severe menstrual pain, cramping, abnormally large blood clots and any abnormal vaginal discharge should be noted to aid with a diagnosis.

The most common cause of a heavy menstrual bleed is related to hormonal fluctuations. These changes may arise for any number of reasons, either due to underlying gynecological conditions, medication, changes in the body’s physiology or with extreme stress to the system as may be seen after a severe illness. Some of these causes can be transient and may not occur again.

Miscarriage may cause heavy menstrual bleeding. Sometimes a heavy period is experienced by a woman who is not even aware that she is pregnant and is the only symptoms of pregnancy and the subsequent loss of pregnancy. It is the body’s way of expelling the products of conception. Women who are aware of their pregnancy need to be cautious about any bleeding during the first trimester, irrespective of the quantity of blood, as it may be a sign of a threatened abortion or ectopic pregnancy.

Polycystic ovarian syndrome and the start of premature ovarian failure or menopause (perimenopause) may be marked with anovulatory periods. This means that an egg cells is not released from the ovary (anovulation) and can disturb the normal hormonal changes in the menstrual cycle. A heavy period or prolonged period can be a symptom of this disturbance.

Growths in and around the uterus may also cause heavy periods. Uterine fibroids and uterine polyps are benign growths of the uterus. Endometriosis is when the endometrial tissue (inner lining of the uterus) occurs at sites outside of the uterus but usually within the pelvis. The different cancers of the female reproductive tract like ovarian cancer, uterine cancer or cervical cancer very rarely cause excessive vaginal bleeding.

Bleeding disorders are conditions where the normal blood clotting process is affected like in hemophilia or von Willebrand’s disease. This can cause heavy and prolonged menstrual periods.

Medication such as drugs used to alter the hormone levels and anticoagulants specifically may lead to abnormalities of menstrual bleeding. Other medication such as anti-inflammatory drugs may also have this effect. Heavy periods can also occur after using the ‘morning after pill’ (emergency contraceptive) and sometimes after discontinuing birth control pills (oral contraceptive).

Sometimes heavy menstrual bleeding  can be related to other diseases apart from gynecological disorders. This may be seen with thyroid disorders and pelvic inflammatory disease (PID).

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