Why some menstruations are heavy

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Not too many women have an idea whether or not their period is “normal”. It’s no wonder, since not only is everyone different, but the stigma still keeps many also from asking questions or discussing what they go through every month with friends and family.

But there is such a thing as bleeding too much. In fact, quite a large number of women experience a clinical condition known as menorrhagia, also called heavy menstrual bleeding. This is when the period is abnormally heavy or prolonged.

For many women, heavy menstrual bleeding is a huge obstacle in their day to day lives. Imagine having to reschedule activities or go home from work because you have soaked through your sanitary towel? Many women know the horrible feeling.

In fact, a population-based, cross-sectional, observational study conducted in five states in the Southeast geographic zone in Nigeria, over a period of 6 months from March to September 2017 found that the most common perceived bleeding symptom was heavy menstrual bleeding (HMB). It was present in 22.2 per cent of the women.

It was in the 2021 edition of the journal, Annals of African Medicine.

It’s common for girls and their parents to wonder if the bleeding with their periods is too often or too much. Especially in the first few years of having a period, any bleeding can feel like too much.

Menstrual flow is usually between two to 10 days, in terms of duration and, averagely, 5 days. The amount of bleeding is usually between 30 to 80 millimetres.

Professor Chris Animakhu, a consultant obstetrician and gynecologist, said what counts as a “heavy” period includes bleeding for more than seven days, bleeding that has a blood clot, even if it is for a few days and bleeding that is more than 100 millimetres.

Having a menstrual flow more than 100 millimetres means that the pad should not be changed for more than two to three times a day and it should be stained, there shouldn’t be any thick clot.

And while doctors often ask how often the girl changes the pad or tampon, that’s very subjective and dependent on personal preference. Some girls change as soon as there is any blood present or every time they use the bathroom. Others wait until they are completely soaked.

In addition, a menstrual bleeding may be too heavy, if it interferes with the ability to go to school, play sports, or otherwise engage in regular activities.

Prof Animakhu stated that there are many reasons why menstrual bleeding is more severe than normal. The most common is fibroid. Also, endometrial polyps, infections, including sexually transmitted infections (STIs), hormonal changes or hormonal imbalances in menstrual cycle, blood clotting problems, endometriosis and pelvic inflammatory disease as well as ovulation disorders could be the reasons in some instances.

However, heavy menstrual bleeding can be more than a mere inconvenience, it is something that should be of concern because it can lead to many health challenges.

“If it is excessive, then the woman must be evaluated because she can have iron-deficient anaemia. The anaemia could be so severe when the woman’s entire volume of blood drops, leading to shortness of breath, feeling nauseous, severe fatigue and increased heart rate.”

Anemia is a condition arising from having too little iron in your body. Anemia can be life-threatening without treatment. Other signs of anemia include a condition called pica. Pica symptoms include hair loss, pale skin, and the urge to eat non-food items like paper, hair or dirt.

Basic tests recommended by the American College of Obstetricians and Gynecologists include a complete blood count and some tests to look for bleeding problems. Along with checking to see if the bleeding has caused anemia.

It is also important to check to see if there might be a problem such as low platelets, or Von Willebrand disease, or some other condition that might be causing bleeding more heavily than normal. Some of these conditions don’t become apparent until a girl starts menstruating. In retrospect, there is often a history of easy bruising and bleeding, or a family history of heavy periods or other bleeding.

There are many other causes of heavy periods. If initial tests don’t show anything and the bleeding doesn’t get better, the doctor may want to check thyroid function as well as some other hormones, and also do some tests to check overall health.

Whatever the treatment will be, Professor Animakhu said, is determined by the cause of the heavy menstrual bleeding, severity of the bleeding as well as the woman’s age, health and medical history. While most cases of anemia are easily treated with oral iron supplements, treatments of heavy menstrual bleeding may include medication or in some cases, surgery.

But going to the doctor armed with information is always useful. For example, it’s good to have an idea of the usual blood loss by tracking how many sanitary items that were used every cycle. Keeping a menstrual diary or using a tracker app can also help, as well as knowing if the condition runs in the family.

It is important to receive help with heavy menstrual bleeding; of course having a more open discussion and raising awareness may help more women get the help and treatment they need sooner to prevent years of unnecessary suffering.

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