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What Causes Heavy And Prolonged Menstruation?

Posted on Mon, 20 Jul 2015

Question: I am 40yrs old and have always had heavy periods. These result in me having to change my clothing frequently and also restricting activities that I enjoy. They rule my life and usually last a full 7 days. Recently they have been more prolonged. Smear tests are normal and intravaginal scan also normal. I have been given Norethisterone as a treatment but want an elective hysterectomy as I am sick of this. I am currently on an activity holiday and unable to participate as when I stand up the blood is pouring from me. No exaggeration. If a normal person loses only a few tablespoons of blood then lucky them. I am most definitely losing more than that. I have Norethisterone with me but didn't want to take this either as when I stop I will bleed again. This is miserable. I have children and don't intend having any more. I just need this to stop. I don't want a coil fitted either as this was suggest as a miracle cure.

Answered by Dr. Deepti Verma (1 hour later)

Brief Answer:
Endometrial biopsy should be done

Detailed Answer:
Hi XXXXXXX I have gone through your question and understand your concerns. Heavy menstrual bleeding is very distressing.
At the age of 40, the cause of such bleeding can be due to hormonal disturbances leading to endometrial changes or can be due to endometrial hyperplasia or carcinoma. This needs to be ruled out by endometrial biopsy and its histopathological examination. The diagnosis can be confirmed only by this method. If norethisterone is not giving you desired relief, then more so the endometrial biopsy should be done. Endometrial biopsy is a office procedure in which your OBGYN specialist will take a chunk of tissue from the uterus using a plastic cannula or aspirator and send it for histopathological examination.
Hysterectomy should be done only when indicated and after confirming the diagnosis. Hysterectomy has its own co morbidities as it is a major surgery, and moreover there is no point in getting an organ removed from the body , if there is a possibility of getting the problem treated by medicines.
In the meantime, you can take tranexemic acid 500 mg 3-4 times a day during periods to reduce the blood flow.
Hope you found the answer helpful. Please do get back for further queries.
Wishing you good health.
Regards,
Dr Deepti Verma

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Deepti Verma (15 hours later)

Many thanks for your advice. I've already had a transvaginal ultrasound so does that procedure not look at the womb? This came back OK with no concerns. I am exhausted and also have lower back pain. I am just concerned that the periods (which are very heavy already) appear to be getting heavier. I have to wear the highest absorbency tampon and sanitary towels which during the heaviest flow only last for a maximum of one hour before soaking through my clothing. My GP does not seem keen to refer me to a gynaecologist but I feel it is necessary. This is affecting my mood too as I am an active person but can't participate in many activities I enjoy due to this. I stopped attending Yoga too as the class was 2 hours long and I would be soaked through with blood after this time.

Answered by Dr. Deepti Verma (10 hours later)

Brief Answer:
Endometrial biopsy mandatory

Detailed Answer:
Hi XXXXXXX thanks for responding.Transvaginal ultrasound only visualizes the uterus and endometriosis. It does not examines the histopathological diagnosis of endometrium.
Endometrial biopsy is mandatory for your diagnosis and you should definitely consult an OBGYN specialist for further management.
Hope you found the answer helpful. Please do get back for further queries.
Regards,
Dr Deepti Verma

Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar