Valley OBGYN Medical Group Inc.

Heavy Painful Menstrual Cycles

Oh those heavy painful days! Every other woman experiences this pain sometime or the other. Do you belong to one of them? Then here is all you need to know about the causes and management of heavy blood loss and gnawing ache during your menses.

Let us first see what is the menstrual cycle?

The menstrual cycle is a hormonal change taking place in woman’s body. The hormones estrogen and progesterone play a key role in regulating menstrual cycle. Each month, these changes prepare woman’s uterus for possibility of pregnancy. An endometrium, a thin layer of lining inside uterus developed naturally by estrogen. This formation of an endometrium is an ideal environment for fertilization of eggs. When there are no fertilized eggs, the estrogen and progesterone levels drop down. As a result the lining of uterus sheds through vagina. This is when a menstrual period starts.

The onset of first ever menses is called as menarche, whereas menopause is the time when menstrual periods stop forever. Normally, the menstrual period starts from early teenage years i.e. 11-14 years and lasts till the age of 45-55 years. The monthly menstrual cycle varies in every woman. It ranges from 21‑35 days with average being 28 days and lasts for about two to seven days. The average amount of menstrual flow is about two tablespoons (30 mL) in an entire monthly period.

What causes menstrual irregularities?

  • Pregnancy or breast feeding: A delayed or missed period is a sign of pregnancy. Also, breast feeding prolongs return of menses post pregnancy.
  • Major weight loss and excessive exercises: Extreme weight loss due to some illnesses or eating disorders like anorexia and bulimia lead to irregular menstrual periods. Additionally, if you are a health freak and exercise heavily to lose weight, there are chances that you might have disrupted periods.
  • Stress: Aggravated stress causes malfunctioning of the hypothalamus, an area of brain that controls hormonal functions. In today’s world, stress is a leading source of unbalanced hormonal activity resulting into irregularity of menstrual cycles.
  • Thyroid imbalances: Thyroid hormones control body’s metabolism. You can have implications on menstrual periods if you have hypothyroidism (low thyroid hormone levels) or hyperthyroidism (higher thyroid hormone levels).
  • Polycystic ovarian syndrome (PCOS): It is a hormonal imbalance causing wide fluctuations in estrogen, progesterone and testosterone levels. This in turn results into inconsistent menstruations.
  • Certain medications: Popping certain medications containing steroids such as birth control pills, medicines for asthma and allergies and chemotherapy medications may lead to abrupt menses.

It is common to have a pain and cramps in lower abdomen, radiating to back and thighs during initial days of menstrual period. An abnormally heavy and prolonged menstrual bleeding with clots (more than 80 mL) is called as menorrhagia. Menorrhagia mostly occurs in combination with dysmenorrhea i.e. an extreme colicky pain in lower abdomen during menses. Having heavy periods can affect a woman’s day to day activities. If you have heavy blood loss and unbearable pain for a long period of time, you need to visit a doctor.

Now let us learn about causes, effects and what you can do for menorrhagia and dysmenorrhea.

What are the causes of heavy and painful menstrual bleeding?

Such occurrences vary highly among women. Diagnosing what exactly leads to heavy periods can be time consuming and challenging task. It is observed that in 40-60% cases, the cause of menorrhagia is unknown. Hence doctors study the patient’s history, signs and symptoms thoroughly. Here are the common reasons known to cause heavy bleeding with throbbing pain.

  • Hormonal imbalances: This is the most common reason for excessive bleeding during teen ages and late forties or early fifties. Hormonal imbalance, particularly in estrogen and progesterone levels; can be observed in adolescents who recently began their periods and women who are approaching menopause.
  • Coagulation disorders: Using blood thinners or anti-coagulants for coagulation disorders like vitamin K deficiency, Von Willebrand disease and hemophilia may lead to painful heavy blood loss during menses.
  • Endometriosis: In this condition, the tissue lining that generally grows along the inner lines of uterus grows outside the uterus. Eventually, this leads to wound formation and excessive bleeding. Endometriosis can also cause severe pricking pain.
  • Endometrial polyps: Polyps are benign growths of tissue mass alongside the inner lining of the uterus. This may cause too much of menstrual bleeding. Before they cause further abnormalities, it is advised to remove them by surgery.
  • Uterine fibroids: These are non-cancerous abnormal growths that form in the muscles of the uterus. Uterine fibroids classically occur in women during childbearing years. Fibroids cause symptoms such as very heavy menstrual bleeding and crippling pain due to pelvic pressure. If the fibroids overgrow in size, they need to be removed by a surgery.
  • Adenomyosis: This is a common cause of painful and heavy periods. In adenomyosis, the endometrial tissues invade and grow into the muscular lining of the uterus.
  • Endometrial and cervical cancer: Development of very thick lining along the inside surface of uterus or cervix is called as endometrial or cervical cancer respectively. This condition leads to irregular menses and heavy blood loss during periods.
  • Pelvic inflammatory disease: It is an infection of uterus, ovaries, fallopian tubes and other organs of female reproductive system. This often leads to excess blood loss and painful menses.
  • Medical disorders of the heart, kidneys, liver or thyroid may also lead to menorrhagia.
  • Intrauterine devices (IUD): These are non-hormonal modes of birth control. Using such devices may lead to very painful and heavy menstrual bleeding. You need to remove IUD to avoid chances of severe infection.
  • Miscarriage: This pregnancy complication leads to a single heavy and painful blood loss.

What are the repercussions of heavy and painful menstrual bleeding?

Following are the effects of heavy blood loss and pain during menstruation.

  • Iron deficiency anemia: It is caused due to excessive menstrual hemorrhage. The signs may include pale, dull skin and weakness
  • Fatigue
  • Headache, nausea and dizziness
  • Shortness of breath
  • Social distress
  • Depression
  • Poor concentration

How is menorrhagia and dysmenorrhea diagnosed?

Your doctor will determine these conditions by carrying out a few of the following tests:

  • Blood test to rule out iron deficiency anemia
  • Ultrasound scan of pelvis
  • Pelvic examination and pap test to detect potential cancerous tissues in cervix
  • Endometrial biopsy to check if there is a possibility of endometrial cancer
  • Hysteroscopy; an examination of uterus. This is carried out under local or general anesthesia

What are the treatment options for heavy and painful menstrual bleeding?

Once the root cause of excess blood loss and stark ache during menstruation has been identified, doctor would commence one of the following treatment modalities. Most healthcare professionals prefer to recommend a medical therapy first before going on to invasive mode of treatment.

  • Non-steroidal anti-inflammatory drugs like ibuprofen and naproxen relieve the pain and reduce the hemorrhage occurrence during menstrual period.
  • Hormonal therapy to regulate menstrual cycles and balance hormonal levels. This would include oral contraceptive pills. Oral contraceptives can reduce menstrual bleeding as much as up to 60% by preventing ovulation and thinning the endometrium.
  • Progestin is the most commonly prescribed medication for menorrhagia. It is known to reduce blood loss up to 15%. The mode of action of progestin is to reduce the effects of estrogen in your body and decelerating the growth of the uterine lining.
  • Placement of hormone secreting IUD. FDA has approved Mirena to treat heavy menstrual bleeding in women who use IUD contraception as their method of birth control prevention. It is recommended for women who have already had a child. It is reported that Mirena decreases menstrual bleeding by 85-90%.
  • Non-hormonal drug such as tranexamic acid to stimulate blood clotting. Tranexamic tablets are known to reduce blood loss by 50%.
  • This means surgical removal of uterus. But, this would lead to inability to bear children in future.
  • This is a surgical procedure to remove fibroids.
  • Endometrial ablation i. e. to abolish the lining of uterus in order to reduce menstrual bleeding.
  • Dilation and curettage. It is a surgical procedure in which the cervix is expanded and uterine lining is scrapped off.
  • Other remedies:
    • Keeping ice packs on abdomen whenever sharp pain arises gives a soothing effect.
    • Iron supplements to replenish lost iron through blood; and vitamin C supplements to help absorb iron more efficiently into the body.
    • Yoga and meditation: This is an alternative remedy which doesn’t have any side effects. Practicing yoga regularly is known to treat menorrhagia by regulating hormonal levels. Yoga relieves severe pain. Performing asnas like ‘uttanasana’, ‘ardha chandrasana’, ‘halasana’ and ‘koormasna’ help in curing menorrhagia. However, these yoga asanas should be practiced under the guidance of trained instructors. Additionally, to overcome menstrual pain and discomfort, meditation and breathing exercises are very beneficial. Fifteen minutes of daily meditation with soothing music tracks relaxes the body thus, reducing stress.

All these treatment options would improve quality of life of women. Women, especially those of childbearing age, should discuss all the above mentioned options with their doctors before making any decisions about how to manage or treat heavy and painful menstrual bleeding.