Average 20-60 ml during the menstrual period blood is lost. The intervals and periods of bleeding are easy to determine but the amount of bleeding is difficult. Increasing the amount of more than 80 ml menstruation is defined as severe menstrual bleeding. In this case, the duration of menstrual bleeding may be prolonged or the duration of bleeding may be increased to 7 days, although the duration of bleeding is limited. Approximately 10-15 percent of healthy women may develop this problem. The average menstrual frequency is every 28 days, if less than 25 days and longer than 35 days it may be a problem.
Why is a severe menstrual bleeding caused?
The main causes of severe menstrual bleeding are hormonal balance disorders. This type of bleeding occurs without uterine or pelvic or systemic disease. This group, where there is no reason, the uterus and the uterus are completely normal, and the hormone and clotting system function normally, are grouped under the heading of dysfunctional bleeding disorder. 1/5 of the examinations and 1/4 of the surgical procedures are performed for this reason. In such a case, differential diagnosis should include pregnancy, various drug use, existing systemic diseases and uterine pathologies such as uterine fibroids and polyps. Adenomyosis, defined by the presence of endometriosis in the muscle layer of the uterus, can also cause severe bleeding. Rarely, uterine cancer itself or its precursor lesions can also cause such abnormal bleeding. In addition, menstrual bleeding may be severe in coagulation system balance disorders that cause the blood to clot and stop the bleeding.
Is fibroids seen in about 25 percent of women have severe bleeding effect?
Fibroids are defined as benign tumors arising from the muscle layer of the uterus. Since they are not a real tumor, they do not metastasize, ie they do not spread to an organ. On the other hand, fibroids give different findings depending on where they are located in the uterus. While uterine fibroids with stem and growing into the abdomen do not cause bleeding disorders, fibroids holding the uterine wall or growing into the uterine cavity are one of the common causes of bleeding disorder.
How is the diagnosis made?
Many pathologies can be demonstrated by taking a detailed patient history and ultrasound examination. If the underlying factor is fibroids, the uterus may be enlarged during the examination. In the diagnosis of polyps, fibroids and cancer, ultrasound examinations performed by injecting fluid into the uterus and hysteroscopy, which is a further examination, have an important role in imaging the inside of the uterus with a camera. Endometrial biopsy diagnoses intrauterine problems in 96% of cases. Hormonal tests can be used to diagnose bleeding due to hormonal factors.
How is it treated?
The general treatment principle is directed to the underlying pathology. In the case of uterine fibroids, it is preferable to remove only uterine fibroids, which is called myomectomy, in young, unborn women, and in advanced age patients who do not respond to hormonal treatment, if the desire to give birth is completed, the uterus may only be removed by laying eggs. As an alternative to excessive bleeding that does not respond to treatment, it is conceivable to burn the inner surface of the uterus using heat or electrical energy.
Polyps that are large enough to come out of the cervix can be surgically removed by holding them from the bottom. Surgical removal is the main treatment for young women since they can cause infertility except for severe menstrual bleeding. Furthermore, the diagnosis and treatment of polyps in the postmenopausal and postmenopausal periods have a different meaning, since polyps may develop with cancer during this period. Since 10 percent of all polyps develop cancer over a period of 1-10 years, they must be removed.
Gynecology Specialist Assoc. Dr. Contact Fatih directly