Approximately 60 % of women experience heavy menstrual bleeding at some point of time in their life . Most of them don’t approach medical help , especially in rural and semi urban areas. The reasons could be lack of support, feeling embarrassed to talk about periods or simply negligence.
Abnormal uterine bleeding means any deviation from normal . So what is normal periods ? Under normal circumstances, the menstrual cycle appears regularly, with the average cycle of once in 23-37 days with menstrual volume of 20 ml to 80 ml , lasting for 3-7 days . Any deviation from the normal pattern is cause of concern . So, if you are changing your pad or tampon every 2 hours for multiple times or passing blood clots bigger than a coin or feeling tired to the extent that its affecting your routine work , then you need to consult your gynecologist for heavy menstrual bleeding.
What is Heavy Menstrual Bleeding ( HMB ) ?
Heavy menstrual bleeding can be either increased frequency or duration in bleeding during menstruation. Apart from making the women anemic, it can cause lot of physical and mental stress . All this affects women ‘s quality of life . Though this can occur in any age group , women between the age group of 41 to 45 years are most commonly affected . Prevalence in India is 17.9 %.There are multiple reasons why the women suffers from HMB. Some of the common causes are endometrial polyps, fibroids , adenomyosis , endometrial dysfunction , ovulatory disorders , endometriosis and less commonly infections or cancer of female genital organs , coagulation disorders and AV malformation . As gynecologists, we do certain blood and imaging studies to arrive at a diagnosis. Some patients may even need to undergo endometrial biopsy. We have lot of options to treat based on diagnosis . The treatment to HMB differs based on the diagnosis .The options can be oral medicines, hormonal injections,or surgical procedures . There is another simpler and safer option of LNG - IUD.
WHAT IS THIS LNG - IUD ? (Levonorgestrel - Intra-Uterine Device)
It s a small T shaped, plastic device which can be placed inside the uterus to control heavy bleeding .This device has a hormone called Levonorgestrel ( LNG ) . It was developed as an option for long term contraception and was first launched in Finland in year 1990. It is approved by FDA to treat heavy periods for up to 5 years. Presently this device is approved as first line of treatment for heavy menstrual bleeding. It is also used in selective cases of fibroids , adenomyosis and dysmenorrhea .
Insertion of this device is a very simple out patient procedure . Insertion and removal does not cause any pain to the women. This device can be inserted even in women who have had caesarean for their delivery . The device has no side effects. I have personally seen women being very satisfied with this device as it reduces bleeding even up to 90 % . These women were relieved that they have avoided a major surgery to remove the uterus.Many brands are available in INDIA and they are very cost effective.
So we urge women to take their health into consideration. As a society , we must encourage women to seek a gynecologist opinion when suffering from menstrual problems. Such novel device are a boon to women , as they can avoid removing the uterus .
At our Birthright , RAINBOW CHILDRENS HOSPITALS ,we see lot of women with menstrual problems from adolescent age group to postmenopausal women . We evaluate our patients, discuss the options with them and offer this solution to those eligible .
Dr. PRIYANKA PADMANABHAN, MBBS, MS, DNB, MRCOG