Dear Doctor,

I am 20 years old and have always had a heavy menstrual flow. I don’t normally get cramps but my flow makes me uncomfortable and I’m afraid of leaving the house when I get a period. I use pads but I’ve tried so many and none is thick enough. I have to change my pad almost every hour. Is there something else you can recommend that can control the flow? I’m told tampons are better but I’m afraid to use them?

Winnie

Dear

Winnie,

Menstruation occurs due to balance of the two hormones estrogen and progesterone. The inner lining of the uterus is prepared to receive a fertilised ovum. Hence, it increases in thickness and new blood vessels are built up making it soft. When fertilisation does not occur, this lining breaks up causing bleeding.

The menstrual cycle of each woman is variable in duration and pattern of flow. Usually it lasts from 28 to 30 days plus or minus one week. Duration of bleeding lasts from three to five days commonly, but can last up to seven days. The bleeding also ranges from mild to heavy. Commonly, it is heavy for the initial two to three days and then reduces and stops towards the end of the menstrual cycle.

Heavy bleeding is inconvenient and it makes a woman susceptible to pelvic infections and chronic anaemia.

Some pathological conditions like hyperthyroidism, uterine fibroids, endometriosis, and etcetera, can cause heavy menstrual flow. It is important to exclude these conditions by a clinical examination and ultrasound.  Treatment of any such condition if present cures the heavy flow as well.

For heavy bleeding which occurs primarily without any apparent cause, one can use drugs that cause clotting of blood and reduce heavy menstrual bleeding, such as tranexamic acid. It can cause digestive disturbances such as nausea or diarrhoea. Non-steroidal anti-inflammatory drugs like ibuprofen, naproxen, are known to reduce heavy flow in 20 to 50 per cent of cases.  They can cause gastritis manifesting as heart burn, nausea and or vomiting. They are also harmful for the kidney, hence, should be used sparingly.

Hormonal therapy is also useful to reduce or stop heavy menstrual bleeding.  Combined pills containing estrogen and progesterone or progesterone alone pills are used for this purpose. Progesterone is also used in form of a small plastic device, inserted in the uterus which releases the hormone slowly in a low quantity. It can be used as a subcutaneous injection. Along with reducing excess flow, it also provides contraception. It can cause heaviness of the breasts as side effects. Estrogen present in mixed pills also aids in contraception. But it carries risk of causing blood clots, lipid abnormalities, heart problems and etcetera as adverse effects.  One desiring to be pregnant should avoid using hormones to reduce or stop excess menstrual bleeding.  Surgical intervention of removing the uterus remains the only option if in spite of drug therapy; one has persistent severe menstrual bleeding.

Vaginal tampons are useful in days of heavy menstrual flow but carry many health risks. They increase the risk of entrance of bacteria and facilitate their multiplication inside vaginal tissue. This can cause toxic shock syndrome (TSS) which is potentially fatal. They also increase risk of bacterial vaginosis. Tampons cause vaginal dryness, resulting in ulcers and chronic vaginitis. They can augment menstrual cramps.

 Dr. Rachna Pande is a specialist in internal medicine.

E-mail- rachna212002@yahoo.