Reasons Behind Prolonged Menstrual Bleeding

On an average, the menstrual cycle lasts for 28 to 35 days, and menstrual bleeding (period) lasts for 4-7 days. When menstrual flow is heavy, or the bleeding lasts beyond seven days, it is referred to as menorrhagia. Bleeding is considered to be heavy when blood loss is more than 80 ml.

Under such circumstances, women might have to change one or more sanitary pads/tampons every hour. They might have to get up during the night to change sanitary pads. Blood loss could even lead to anemia. This is certainly a very discomforting condition, which can adversely affect one's ability to perform routine activities.

Prolonged menstrual bleeding could be caused due to the following conditions.

Estrogen and progesterone are female sex hormones responsible for cyclical changes that occur during the menstrual cycle. The rising level of estrogen is responsible for the thickening of the endometrium (uterine lining). An increase in the level of luteinizing hormone during the middle of the menstrual cycle triggers ovulation (release of a ripened egg).

If the egg is fertilized with a sperm, progesterone levels increase. Progesterone prepares the endometrium for the implantation of the fertilized egg. In case the egg and sperm don't fertilize, progesterone levels decline. This is followed by the shedding of the uterine lining (menstruation/period).

In case of women affected by hormonal imbalance, the uterine lining could develop in excess. Under such circumstances, menstrual flow might be heavy and the bleeding might last for a longer period.

Uterine fibroids are benign or noncancerous growths that develop in or just outside the uterus. These form due to an overgrowth of the smooth muscle cells of the uterus. The exact cause of fibroids is not known, but it is believed that their growth could be linked to estrogen.

Uterine fibroids could cause heavy and painful periods, bloating, problems related to bowel or bladder, pain during sexual intercourse, etc.

Polyps are benign growths of the tissue that lines the uterus. They are more likely to affect women in their 40s. Polyps could also develop on the cervix. These are connected to the underlying tissue by a base or stalk. The symptoms of uterine polyps include irregular vaginal bleeding, heavy bleeding, and bleeding after sexual intercourse.

Adenomyosis is a condition that is characterized by the abnormal growth of endometrial cells within the muscular layer of the uterus. It can lead to the enlargement of the uterus, and give rise to symptoms such as excessive bleeding, bleeding between periods, painful periods, and painful intercourse.

If a pregnant woman experiences heavy and prolonged bleeding, abdominal pain, and severe menstrual cramps, then it could be a sign of miscarriage.

In case of an ectopic pregnancy, the egg gets implanted in the Fallopian tube, ovary, abdomen, or the cervix, instead of getting implanted in the uterus. Vaginal bleeding could be a symptom of ectopic pregnancy.

Besides these, menorrhagia could occur due to use of an intrauterine device or prolonged use of certain drugs (blood thinners). Pelvic inflammatory disease, medical conditions that affect blood clotting, infection of the reproductive organs, ovarian cancer, uterine cancer, cervical cancer, etc., are some conditions that may cause heavy vaginal bleeding.

The treatment would depend on the underlying cause. Oral contraceptives might be prescribed for regulating the menstrual cycle. Iron supplements might also be prescribed for preventing anemia. In some cases, the administration of oral progesterone might be recommended.

At times, the doctor might recommend the use of an intrauterine device (IUD) that releases levonorgestrel (a type of progestin). This might help reduce bleeding by thinning down the uterine lining. If bleeding is accompanied by cramps, doctors might prescribe non-steroidal anti-inflammatory drugs (NSAIDs). These might also help reduce blood loss.

If drugs fail and prolonged bleeding affects health, surgical options such as endometrial resection (use of electrosurgical wire loop to remove uterus lining), dilation and curettage (scraping off or suctioning tissue from the uterine lining), endometrial ablation (surgical destruction of the uterine lining), hysterectomy (removal of the uterus) may be used.

However, endometrial ablation, endometrial resection, and hysterectomy are not recommended in case of women who wish to get pregnant. So, if the woman is of childbearing age, the treatment might be restricted to drug therapy.

Prolonged bleeding can result in excessive loss of blood, which can lead to anemia. So, along with the following the suggested treatment option, it is very necessary that the woman follows a balanced, healthy diet, which is rich in iron.

Disclaimer: The information provided in this story is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.