over flow in periods

Thank you for consulting with us at Doctor spring. I understand that your periods are very heavy and also of late you have started to feel faint. I would like to know your age, your age at menarche, number of children if any, and similar previous history.

Menorrhagia is the term used to denote cyclical regular bleeding which is excessive in amount or duration. The normal menstrual blood flow is 50 to 80 ml and does not exceed 100 ml. In menorrhagia, the menstrual cycle is unaltered but the duration and or the quantity of menstrual blood loss is exceeded. Menorrhagia is essentially a symptom and not in itself a disease.

The causes are several. They include:

• Blood clotting abnormalities: leukemia, inherited coagulopathies like von willebrands disease, severe anaemia, idiopathic thrombocytopenic purpura.
• Thyroid dysfunction: both a lower than normal (hypothyroidism) and higher than normal level (hyperthyroidism) of thyroid hormones can cause menorrhagia. But, it occurs only in the initial stages of hyperthyroidism.
• Uterine fibroids, adenomyosis, endometrial hyperplasia
• Ovarian disease
• PID and genital tuberculosis
• Immediately after giving birth and after an abortion
• Sometimes, the mini pill which contains only progesterone can also cause unpredictable bleeding and menorrhagia
• IUCD insertion may sometimes cause excess bleeding

The possible investigations that a Gynecologist would do before diagnosing the cause for your menorrhagia, you may go through the following tests depending on the needs of the doctor:

• Complete hemogram
• Bleeding and clotting time
• Thyroid profile
• Ultrasonography
• Endometrial study by curettage

Some general measures you could take are to improve your general health. Eat healthy and exercise regularly. Adequate rest during menses is also important. Maintain a menstrual calendar each cycle and note the number of days of bleeding and the umber of napkins changed or tampons used.

You could take oral Non steroidal anti inflammatory drugs like Mefenamic acid 500mg three times a day on days of very heavy flow and pain. The medication is to be taken after a meal. Blood loss could be reduced by 30 to 40% with these medications alone. These are especially useful in ovulatory cycles. In case your doctor detects any obvious pathology in your examination, the key to reducing menorrhagia is treatment of the cause. The reason why you feel faint is probably because you are severely anaemic. You should immediately receive medical help because oral iron supplements may not be enough for you.

In some cases the doctor may not find any obvious pathology after ruling out all the possible differential diagnoses. In such cases the condition is termed as Dysfunctional Uterine Bleeding. It is due to hormonal changes and there is an increased amount of estrogen in the blood leading to overdevelopment of the endometrium in each cycle and so when the endometrium is shed, there is an increased bleeding.

Some patterns of DUB have been observed and based on these they are in turn divided into several types.

1. Puberty menorrhagia: Here the estrogen excess is because the ovum does not develop just after puberty and hence, there is no progesterone to balance out the estrogen.
2. Premenopausal menorrhagia: This is also because of an ovulatory cycles.
3. Metropathia hemorrhgica: Due to ovarian dysfunction

Depending on your diagnosis, you can discuss treatment options with your Gynaecologist. Hope this information was of us to you.