Dr Sharifah (right) working on removing a uterine fibroid from a patient.
ARE you suffering from heavy mentrual loss monthly?
Madam R, a 42-year-old teacher, complained that recently she felt easily tired, had shortness of breath and her heart was pounding fast at the slightest activity.
She often feels sleepy and not up for doing her usual house chores.
Her period had been regular and lasted about seven to 10 days.
The first few days of her menses, she soaked about six pads a day and some blood clots would be included in the flow.
However, Madam R regarded her menstrual blood flow as normal.
Upon examination, she was pale and her haemoglobin level was 5.2g% (normal levels are 11g%-16g%). She was diagnosed with severe anaemia which warranted blood transfusion.
She was admitted to hospital for further investigation and for a blood transfusion.
Tests indicated that Madam R had severe iron deficiency anaemia.
Many women have severe iron deficiency anaemia because of chronic blood loss through menstruation which they regard as “normal” menses.
It is not surprising that they do not seek treatment until they experience symptoms of anaemia, with a few having their case complicated by heart failure when they finally seek the advice of a doctor.
Heavy menstruation or “menorrhagia” is a common condition affecting young women after their menarche (first period) and during their reproductive years. It is defined as blood loss through menstruation of more than 80ml per cycle.
What is normal menstruation?
A woman usually loses approximately 40ml to 60ml of blood monthly through menstruation.
The duration of five to seven days and the period interval of 21 to 35 days are accepted as normal.
A woman is said to have abnormal menstruation if the blood loss at menstruation is more than 80 ml or when the period is prolonged for more than 10 days and if the interval period is shorter than 21 days (counting from the first day of the last menstrual period).
If more than two pads are soaked a day, blood clots discharge with the flow and there is flooding of menstrual blood, the woman should seek the advice of a doctor.
Ironically, many women regard heavy menstruation as good and healthy as more “dirty blood” is flushed out from the body and they are very concerned when they bleed less.
What causes heavy menstrual blood loss?
There are many causes of heavy menstruation. In adolescence, it is commonly the result of dysfunctional uterine bleeding. Many people refer to it as a “hormonal problem” when there is no specific cause found.
Dysfunctional uterine bleeding occurs because of incoordination of hormonal action causing the inner layer of the uterus called endometrium to shed excessively and the failure of local hemostasis mechanism to control blood loss during menstruation.
This results in heavy menstrual bleeding and a depletion of iron. Iron is an important element in our blood that helps to carry oxygen throughout our body.
In older women, especially those in their early 40s, dysfunctional uterine bleeding, uterine fibroid and endometrial polyp are also common.
In medical literature, it is estimated that about one in three women have uterine fibroid. Most of them are asymptomatic and often found incidentally during medical check-up for some other reason. Some medical studies reported only about 20% of uterine fibroid are symptomatic and need medical attention. Among the most common symptoms are heavy menstrual bleeding and palpable uterine mass or tumour in the lower abdomen that compress adjacent organs such as the bladder, ureter and bowel. The effect of prolonged compression to the adjacent organs may bring about urinary and bowel symptoms such as frequent urination and constipation.
In women close to menopausal age and beyond, heavy menstrual loss may signal something worse than dysfunctional uterine bleeding. Women around this age must be screened for uterine cancer.
According to the cancer registry statistics, uterine or womb cancer is the fourth most common cancer affecting women in Malaysia after cancer of the breast, colon and cervix. Thus, older women who have heavy menstrual bleeding cannot be dismissed as having hormonal problems before a full investigation is done to find out the cause of the heavy bleeding.
What are the complications associated with heavy menstrual loss?
Heavy menstrual loss for a period of time is a threat to women’s health if it is not treated. It is the number one cause of iron deficiency anaemia in women which may bring about poor work performance and affect productivity at work or at school.
Anaemia, if left untreated, would eventually strain the heart and could lead to heart failure.
Iron deficiency anaemia may lead to a rapid or irregular heartbeat. The heart must pump more blood to compensate for the lack of oxygen carried in the blood when a woman is anaemic. This can lead to an enlarged heart or heart failure.
In young adolescents, severe iron deficiency anaemia affects their growth and development into adult women. Additionally, iron deficiency anaemia is associated with an increased susceptibility to infections.
Studies have also shown that in pregnant women, severe iron deficiency anaemia has been linked to premature births and low birth weight babies.
