Secondary : due to a cause : such as intra uterine device,
administration of sex hormones for contraception or other purpose; or
organic disease outside the reproductive system.
The normal variation in cycle length in different women is anywhere
between 23 - 40 days with duration of anywhere between 2 - 7 days. Any
menstruation outside these limits, any bleeding at other times in the
menstrual cycle and any acyclical bleeding at or around the menopause
should always be regarded as abnormal.
Blood loss during the period is normally between 40 ml to 80 ml i.e
about one to two and a half small cupsful. However, what is excessive
for one patient may not be excessive for another as he is used to more
blood loss. However, it is important to know this as bleeding more
than
this will lead to anemia.
The age incidence of this problem is commonly 5 - 7 years after the
start of the period and prior to menopause. It may of course occur at
any time through the reproductive years also. Contraception with the
'pill' reduces menstrual blood loss and the intrauterine device (loop)
increases the same.
The passage of clots always indicates excessive menstrual loss.
It may be associated with bleeding disorders & hypothyroidism which
should be excluded by the doctor.
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Management depends on age group
Excessive regular cyclic bleeding if not due to any organic cause
usually settles. Irregular or acyclic excessive bleeding or
intermenstrual bleeding should be investigated promptly to exclude any
cancer. An ultrasound of the pelvis and / or curetting may have to be
undertaken.
General measures
- To keep a menstrual calendar - record the number of pads changed /
day, the extent to which they are soaked and the number of days
bleeding
occurs.
- Oral iron, calcium and vic C with supplements.
- Treatment of secondary disease eg intrauterine device (loop) may
have
to be removed, thyroid disease may have to be treated. Specific
measures include treatment with hormones, drugs which control blood
loss
in other ways eg. Tranexamic acid, mefenamic acid. A curettage
sometimes helps control the bleeding. Rarely, a hysterectomy (removal
of uterus) may have to be undertaken in a woman who does not respond to
medical treatment and has completed her family. Recently, several
methods of burning or removing the lining of the uterus have been
devised.
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