Menstrual blood flow with clots

Women of reproductive age group have monthly menstrual cycle  & she should bleed 4-5 days normally with average blood loss of upto 60-80 ml.

However if she bleeds more than 80  ml with passage of blood clots or if period continues more than 7 days, it is known as heavy menstrual flow or menorrhagia.

Menorrhagia is a  major part of abnormal uterine bleeding & can interfere with the mental, physical & social life of a woman.

She can develop anemia with symptoms of breathlessness and fatigue.

Causes of menorrhagia

• Patients can have heavy flow due to estrogen, progesterone imbalance & such kind of problem is common in the young age group.
• Adenomyosis (a condition in which the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus) & intramural fibroid ( tumors that typically develop within the uterine wall and expand from there) can also cause heavy menstrual flow.
• Use of blood thinners in DVT patient or cardiac patient can again cause abnormal heavy flow
• Liver and kidney disorder can be responsible for menorrhagia

Management of menorrhagia-

Management depends on cause of menorrhagia.

• Hormonal imbalance can be managed with oral progesterone or estrogen-progesterone combinations.
• Adenomyosis or small fibroids can be managed medically with insertion of progesterone releasing device in uterine cavity,
• Endometrial ablation is first line treatment by a gynecologist if uterus is less than 10 weeks of size. It involves removal of the full thickness of endometrium together with superficial myometrium & basal glands, it retains uterus.
• However large fibroids can be managed surgically either by laparoscopic myomectomy or laparoscopic or open hysterectomy if patient is near menopause. Surgery, and in particular hysterectomy improves heavy menstrual bleeding more effectively than medical options. However because of reversibility of medical treatment and the added risk & complications of surgery, surgical treatment is not usually considered first line.
• Even patients can go for uterine artery embolization if she is having multiple small fibroids.

Do women with menorrhagia need PAP Smear?

Women with menorrhagia can go for routine Pap Smear after cessation of bleeding. Menorrhagia is associated with a functional or structural disorder of uterus & Pap Smear is done to rule out cervical disorders.

So it is not mandatory for women with menorrhagia to go for PAP smear.

However, patients with post-coital bleeding should undergo local examination & PAP smear in the maternity hospitals.