Some women sometimes experience excessive bleeding when they are menstruating, bleeding during pregnancy or some days after they have had their normal menstrual bleeding; in addition, this bleeding may be prolonged, lasting longer than a week.
This abnormal menstrual bleeding is due to a disruption of the normal hormonal regulation of the wall of the womb in a menstrual cycle. Normally, during each menstrual cycle, the ovaries allow some egg-containing structures in them (follicles) to grow; the wall of the womb is nurtured to also grow in preparation for a possible pregnancy by a chemical substance (hormone) called oestrogen. Towards the middle of the cycle (for women with 28 days cycle), one of the egg-containing structures from one ovary ruptures and expels the egg (ovulation). If the woman doesn’t have sex around or a few days after this period, no sperm will be available to fertilise the expelled egg. The egg gradually breaks down while the growth of the wall of the womb stops due to the withdrawal of the chemical substance called oestrogen. This causes the wall of the womb to begin peeling off all the growth it underwent, resulting in the normal menstrual bleeding every woman has in each menstrual cycle.
However, if the chemical substance called oestrogen, which nurtures the growth of the wall of the womb, refuses to withdraw after the ovulated egg has broken down or even when there is no ovulation, the wall of the womb will keep growing to a point where its blood supply will not be enough. This leads to a breakdown of the wall and excessive bleeding from the womb through the vagina.
Abnormal menstrual bleeding is caused by different factors depending on the age of the woman. For girls who attained puberty a few years before the abnormal menstrual bleeding, ovulation not occurring in a menstrual cycle is a major cause. Also, bleeding disorders in this age group has been found to be another cause of abnormal menstrual bleeding. In this case, such a girl may have a history of excessive normal menstrual bleeding since she first saw her menses; a history of bleeding disorders in her family; or a personal history of bleeding from any part of the body without any obvious injury or bleeding from the nose for many minutes. The parents in this case must not hesitate to take their daughter to the hospital to see a gynaecologist where they may be sent to another doctor called a haematologist with specialty in treating diseases of the blood.
Abnormal menstrual bleeding in women who have started having children could be a sign of a miscarriage of a few weeks old pregnancy, an ectopic pregnancy or it could be due to non-occurrence of ovulation during a menstrual cycle. Such women will require the attention of a gynaecologist for emergency treatment which will likely involve surgery.
Fibroids and absence of ovulation are the common causes of abnormal menstrual bleeding in women who are getting towards menopause (late 40s); while the shrinking of and cancerous transformation of the wall of the womb are the major causes of abnormal menstrual bleeding in women who have passed through menopause. Treatment in this case depends on whether it is a fibroid or a cancerous transformation of the wall of the womb causing the abnormal menstrual bleeding. The gynaecologist will discuss with the woman on the best treatment options available, their benefits and risks and allow her make a decision on the preferred treatment option.
Treatment with drugs such as the combined oral contraceptive pills or the use of the copper-containing intrauterine contraceptive device can also result in abnormal menstrual bleeding as a side effect.
Abnormal menstrual bleeding, especially the heavy and prolonged menstrual bleeding, predisposes the woman to an unusual amount of blood loss if it occurs repeatedly. The woman is also at risk of developing iron deficiency anaemia. But the greatest danger is the possible transformation of the wall of the womb to cancer (endometrial cancer) due to the repeated stimulation of the wall by the hormone, oestrogen. The surgical removal of the womb and ovaries, especially if the woman has stopped giving birth, may be the best treatment option in this case.
Treatment of abnormal menstrual bleeding requires the affected woman visiting a gynaecologist who will take a detailed medical history from her, carry out a complete physical examination on her, and conduct several medical investigations before arriving at the actual cause of the problem. After this, the doctor will now discuss the various treatment options with her.
For young ladies experiencing heavy normal menses for the first time and which probably lasts more than a week, using medications such as ibuprofen available over-the-counter may help in controlling the bleeding. But the ibuprofen must be purchased from a good pharmacy and taken according to the dosage instructions written on the pack or as directed by the pharmacist. In addition, such ladies should ensure they visit a doctor, preferably a gynaecologist for full medical attention.
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