Heavy menstruation: a nightmare for many women?

Menstruation is a physiological process that begins in a woman before puberty and ends at menopause.

It typically occurs around the age of 12 and ends around the age of 50. However, the exact beginning and end is individual.

During it, a woman loses about 50 ml to 80 ml of blood mixed with the remnants of the mucous lining of the endometrium.

The physiological menstrual cycle

The normal menstrual cycle lasts an average of 28 days. However, it can vary individually.

A cycle of 21 to 35 days is also considered physiological. The duration of bleeding is 1 to 7 days.

Bleeding should be light - a woman should not change more than one pad or tampon for three hours.

Small variations that occur regularly in a particular patient can also be considered normal (heavier bleeding, weaker bleeding, shorter bleeding...).

The menstrual cycle has three phases. These are the menstruation itself, the follicular phase and finally the ovulation phase. The beginning of the cycle is considered to be the first day of menstruation.

Interesting:
During the menstrual cycle, about 20 follicles are formed.
Of these, only one, or occasionally two, develop into a fully functional egg suitable for fertilization.
If fertilization does not occur, the egg survives only about 24 hours after ovulation.

Menstrual cycle phases table:

Menstrual cycle disorders

Menstruation is usually uneventful, but many women experience menstrual cycle disorders.

They can also indicate serious diseases of the female genital organs or other illnesses.

Table with menstrual cycle disorders:

Why do some women bleed excessively?

The length of bleeding during menstruation and its intensity is individual.

In principle, menses should not last more than seven days. A woman normally changes one pad or tampon after three hours.

When is bleeding pathological?

Excessive, pathological bleeding is professionally called menorrhagia. Every woman knows her usual cycle and each can judge whether the bleeding in question is normal.

Menorrhagia is manifested by heavy bleeding when the patient's usual amount of sanitary products is not enough.

The consumption of pads is at least one per hour and blood clots often appear in the blood. The condition lasts for more than 7 days, in worse cases more than 12 days.

Manifestations of hypovolaemia and anaemia are also present. Menstruation is accompanied by pain.

When is it necessary to consult a hematologist?

Not every gynecological bleeding has its cause in gynecology. In some cases, the problem is in the blood. In such cases, the help of not only a gynecologist, but mainly a hematologist is necessary.

The most common hematological causes of gynecological bleeding include anticoagulation therapy, Willebrand's disease, congenital factor VII deficiency, hemophilia.

Interesting:
Diagnosis of hematological abnormalities is a separate chapter of gynecological bleeding.
Willebrand's disease is most commonly encountered in adolescent females.
This disease is one of the coagulopathies due to a deficiency of a plasma protein also called factor Willebrand. It is the most common congenital bleeding disorder, manifested mainly by mucosal bleeding (gums, uterus, nasal mucosa).

Are you also suffering from severe pain?

During menstruation, the old endometrium is shed with blood through the vagina.

This process is usually slightly painful at the time of uterine contractions. The body tries to get rid of the already separated parts of the mucous membranes by means of contractions.

This is why women experience slight pain in the lower abdomen during menstruation. Sometimes the pain radiates to the sacral area.

Pains that we consider normal

Painful menstruation is called dysmenorrhea. Pains of moderate and stronger intensity can be physiological and are equally strong from menarche.

In this case, the pain can be considered physiological, and it is called primary dysmenorrhea.

The pains are usually crampy, radiating to the back or groin. They are accompanied by other symptoms such as nausea, vomiting, bloating, diarrhea, constipation, weakness, dizziness, headaches, and others.

Pains that may indicate a problem

If a woman has not been having painful menstrual periods, and these come with time, it may indicate a problem in the sense of some disease.

Most often, secondary dysmenorrhea appears after the age of 30 and is a sign of a pathological process.

In this case, crampy pains are in the foreground. Other manifestations as in primary dysmenorrhea (nausea, vomiting) do not occur at all.

The most common causes of heavy menstruation

Heavy menstruation is when a woman bleeds for more than 7 days, or bleeds through more than 6 pads or tampons per day. By the term heavy menstruation we also mean the presence of primary or secondary dysmenorrhea.

Some women have suffered from heavy menstruation all their lives, it is physiological for them. They ease these days of "suffering" with pain killers, local application of heat to the abdominal area and forcing a position of relief.

A woman who previously had a weak period and now has a strong and painful one should not underestimate this condition. Anything that is out of the normal deserves our attention. Anything that is different from before may indicate a pathology in our body.

Endometriosis

Endometriosis means a disease where there is a growth of endometrial tissue outside the uterine cavity. It occurs in women of childbearing age.

It is manifested by chronic pain not only in the lower abdomen but in the entire pelvic area, called pelvipathia. These are usually not severe in intensity but are constant. Sometimes they shoot up to the sacral area - sacralgia.

Women also experience pain during sexual intercourse (dyspareunia) or during defecation (dyschezia).

Interesting:
The first symptom or cause of a woman's visit to the gynaecologist is the inability to conceive.
If this is successful, the problem of carrying a baby comes into play. Miscarriages are common in patients with endometriosis.

Polyps on the uterus

Endometrial polyps are benign growths that are stem-shaped and protrude into the uterine cavity. They are found on the body or cervix.

They are the end result of excessive local growth of the endometrium. They occur mostly in older women.

Most minor polyps are diagnosed incidentally, during a routine gynaecological examination. They do not usually cause major problems.

Larger polyps are manifested by a feeling of pressure in the lower abdomen or pelvis. The pain is not severe, sometimes it is just a feeling of tightness or fullness.

However, painful menstruation or heavy bleeding during menstruation can be distressing.

Cysts

A cyst is a pathological formation that is enclosed from other tissues by its own epithelial lining. Its interior consists of a cavity that is filled with sparse but also dense contents.

It arises from various causes (hormonal, tumoral, obstructive).

Gynaecological cysts arise at the sites of the female genital organs. They are most often found on the ovaries, but can also be observed in the vagina or on the Bartolini gland.

Cysts are manifested by pain in the lower abdomen. They are usually located on one side, especially if it is an ovarian cyst (cyst on the ovary).

Painful menstruation is typical. It is accompanied by heavy menstrual bleeding or, conversely, light bleeding or even amenorrhoea (absence of menstruation).

Bleeding and severe pain are also present with cyst rupture or ovarian torsion.

An ovarian torsion means that the ovary with the cyst turns on its axis, causing a constriction of its blood vessels and a problem with the nourishment of this organ. It may die.

Fibroids

Fibroids are benign tumours of the uterus, growing out of its muscular tissue - the myometrium. They are the most common cancer in women after the age of 30.

The causes are not fully understood, but a genetic predisposition and hormonal fluctuations of estrogens and progesterones are thought to be responsible.

Smaller fibroids do not cause a woman any discomfort. Like polyps, they are discovered accidentally during a preventive examination.

Fibroids of larger size are a common cause of heavy menstruation and cause severe menstrual pain.

Pain also occurs outside of menses in the lower abdomen and sacral area. Soreness during intercourse is also not uncommon.

Heavy menstrual bleeding is also common. Genital bleeding also occurs outside the menstrual cycle.

Problems with urination and defecation are also unusual. Pressure on the bladder causes more frequent urination, pressure on the ureter causes problems with urination. Bowel pressure results in constipation, bloating and even increased abdominal volume.

Gynaecological tumours

Female cancers are a common cause of painful menstruation, heavy menstrual bleeding, as well as other menstrual disorders and various symptoms.

Tumours can occur in any part of the female genital tract.

The growth of the tumours causes pressure and pain in the area and later diffuse to the surrounding area.

Pain during sexual intercourse is also often present.

Obstruction by a tumour results in disruption of the menstrual cycle, disturbances in urination and defecation. If the surrounding blood vessels are damaged, it can cause heavy bleeding outside the menses.

Anticoagulant treatment

The term anticoagulant treatment refers to therapy that lowers the levels of coagulation factors and thus literally "thins the blood".

It is used in patients at increased risk of blood clots. These include patients with atrial fibrillation, pulmonary embolism, acute myocardial infarction, stroke, and deep limb thrombosis.

It is also used after trauma and some surgical procedures to prevent blood clot formation and subsequent complications.

A side effect of anticoagulants is unwanted bleeding conditions.

These most commonly manifest as nosebleeds, excessive bleeding after tooth extraction, heavy menstrual bleeding, presence of blood in the urine, and others.