Heavy Menstrual Bleeding

• Changing a sanitary pad or tampon more than once an hour for several hours in a row
• Getting up at night to change sanitary pads or tampons
• Bleeding for more than a week
• Frequent passing of large clots
• Experiencing excessive menstrual flow that soaks through pads, causing leakage onto clothing or bedding
• Unable to do daily activities due to heavy menstrual bleeding
• Feeling fatigued or experiencing shortness of breath due to anaemia resulting from HMB
  

Women should consult a healthcare provider if they experience any of these symptoms.

Early intervention can prevent complications associated with HMB and severe iron-deficiency anaemia.

The causes of HMB vary across different life stages and may include:

• Irregular ovulation or other hormonal imbalances 
• Structural changes in the womb: polyps, fibroids, or adenomyosis
• Clotting disorders caused by blood thinners or underlying medical conditions
• Precancerous conditions such as endometrial hyperplasia

It is also essential to rule out cancerous growths in the womb or cervix which may present with frequent and irregular bleeding.

Menstrual blood loss depletes the body's iron reserves, as iron is vital for producing red blood cells. Chronic heavy bleeding can outpace dietary iron intake, leading to iron deficiency anaemia over successive menstrual cycles.

Symptoms of Iron-deficiency Anaemia
While mild iron deficiency may not present noticeable symptoms, severe anaemia can manifest as:

• Fatigue and light-headedness
• Shortness of breath
• Palpitations or chest discomfort
• Pale complexion
• Reduced exercise tolerance

These symptoms often develop gradually, and individuals may not recognise them until anaemia is severe.

If left untreated, severe anaemia can lead to life-threatening complications such as heart attacks, strokes, fainting, or falls.

To determine the cause of HMB, your doctor may do the following;

• Take a detailed medical history
• Perform a physical examination to assess the cervix and womb
• Conduct a detailed gynaecologic ultrasound 
• Perform a bedside biopsy of the womb’s inner lining (endometrium) in the clinic
• Conduct a hysteroscopy, a day or outpatient procedure using a camera to examine the womb 
• Obtain a sample of the endometrium through a dilation and curettage

To diagnose iron-deficiency anaemia, the following blood tests may be performed: 

• Full blood count
• An iron panel, which may be performed simultaneously or as a step-wise approach to determine the extent of iron deficiency

Managing HMB and preventing iron-deficiency anaemia involves:

• Iron supplementation: To replenish iron reserves.
• Medications: Non-hormonal tablets like tranexamic acid or hormonal medications that can be given as tablets, injections, or implants in the womb to reduce menstrual flow.
• Surgical interventions: Procedures such as fibroid removal, or removal of womb (hysterectomy) may be necessary, depending on the underlying cause.
• Uterine artery embolisation: A non-surgical procedure may be offered to selected patients where a radiologist passes a wire through the groin into the blood vessels supplying the womb, with the goal of reducing blood flow to the womb and thus, shrinking it and reducing HMB. 

A thorough evaluation, including physical examination and ultrasound of the womb, together with a woman’s fertility plans guides the appropriate treatment strategy.

Incorporating iron-rich foods into the diet is beneficial. Sources include:

• Red meats
• Leafy green vegetables (e.g. spinach, broccoli) 
• Legumes (e.g. beans, peas)
• Nuts and seeds