What causes prolonged menstrual bleeding?

Dear Doctor,

My period usually lasts longer than a week, however, this month, it has gone beyond that. I have had it for over two weeks now and the bleeding is heavier than usual. This is accompanied by dizziness and nausea. Is this something I should worry about?

Lyna

Dear Lyna,

What is your age currently? A woman having normal regular menstrual cycles previously can have irregular cycles around menopause. This happens because the balance of hormones governing the menstrual cycles changes at this age. Actual cessation of menses occurs some time later around 50 years of age, some years sooner or later. But the changes start from around 40 years or so. This is manifested in the form of irregular periods with scanty or prolonged and heavy bleeding. 

Though this change in menstrual cycles is normal, if recurrent or persistent, it is a cause for concern.  

Excess bleeding due to menopause is diagnosed clinically and by investigations to exclude other causes of prolonged bleeding. Treatment is by hormonal therapy. But at this age, it is necessary to weigh the advantage of hormonal therapy, versus the potential harm caused due to its side effects like clotting, hypertension, heart problems, and et cetera. Iron supplements are given if anaemia occurs.  In severe cases, the uterus is removed surgically.   

Heavy and or prolonged bleeding can be due to uterine fibroids. Fibroid is benign tumour that develops in the inner lining of uterus and can be small or big in size, single or multiple in number. Apart from heavy and or prolonged menstrual bleeding, they can cause lower abdominal pain, discomfort and backache. Fibroids are easily diagnosed by ultrasound. Treatment is by hormones or surgery.

Excess and or prolonged bleeding during menses can be due to other hormonal disorders. Hyperthyroidism, i.e. excess amount of hormones released by thyroid gland is one of them. This can occur at any age. Other manifestations of hyperthyroidism like excess sweating, tremulousness of hands, increased appetite, altered bowel movements, to mention a few, may be present or absent, along with excess menstrual bleeding. Hyperthyroidism is easily diagnosed by a simple blood test and is treatable.  Hypopituitarism, adrenal gland disorders are other endocrine ailments, which can cause prolonged menstrual bleeding. These disorders are also easily diagnosed and are treatable. 

Excess menstrual bleeding can be a side effect of anti-clotting drugs like aspirin and clopidrogel. Some women may develop it as a manifestation of inherent bleeding disorders. 

Heavy and or prolonged bleeding mostly results in chronic anaemia, i.e., deficiency of necessary amount of haemoglobin (component of blood that carries oxygen to the body cells). This manifests as early fatigue, joint pain, palpitations and breathlessness on exertion. Over time, chronic anaemia puts strain over the heart resulting in heart failure. This is prevented by treating heavy bleeding during periods. Treatment depends on the cause.

 Dr. Rachna   Pande is a  specialist in internal medicine.