Variation in the length of the menstrual cycle and the occasional missed period are parts of every woman’s life, especially in puberty and as the menopause approaches. Irregular cycles at other times are only something to worry about if there are less than four periods per year, bleeding more often than every three weeks or if bleeding is very light. The cause is ally hormonal. Whether or not treatment is needed depends on whether you want to conceive or have symptoms of oestrogen deficiency.
It can be hard to realize that your periods are heavier than normal, especially if the increased loss has come on very gradually. If you soak through or overflow a pad a tampon in less than an hour more than three times in a row on any one day of menstruation, or if bright red flow god on continuously for more than 48 hours – that’s too heavy.
Repeatedly losing more than 80 ml о blood at each menstruation can lead to anaemia, so heavy periods should always be investigated to find and correct the cause.
Failure to ovulate or faulty corpus-luteum formation result in progesterone deficiency in the second hi of the menstrual cycle. If the endometrium is stimulated by oestrogen without out sufficient progesterone, it will growl thicker, and its blood vessels won’t thicken and coil enough to close down efficiently when menstruation begins. An ovulation is the usual reason for heavier menstrual bleeding early in puberty and around the menopause. Lack of progesterone is also the reason for the heavier periods that are often an early sign of polycystic ovaries.
Heavy periods in women with endometriosis are also believed lobe the result of overgrowth of the endometrium due to faulty corpus-luteum formation and relative lack of progesterone.
Heavy periods resulting from lack of progesterone can usually be corrected by taking oral progesterone. The combined oral contraceptive Pill, if appropriate, usually works well to reduce menstrual blood loss.
Prostaglandins are also important in the control of bleeding when the endometrium is shed; they affect blood vessels aid contractions of the uterus. In some leases of heavy menstrual bleeding where no other cause can be found, treatment with antiprostaglandin medication is successful.
Uterine causes of heavy periods include:
• inflammation of the endometrium
• anything that increases the surface area of the endometrium, such as a fibroid protruding into the cavity of the uterus or septate uterus
anything that prevents the uterus from contracting properly, such as fibroids within its wall
•cancer of the endometrium; heavier periods can be an early symptom
Disorders of blood-clotting usually cause other symptoms – such as excessive bruising, prolonged bleeding from minor wounds and small haemorrhages under the skin – as well as increased menstrual blood loss. However, tests for blood-clotting are always done if no other cause can be found for heavy periods.