By Dr. Madiha Masood


Being a woman essentially means having a considerable part of your life spent in the awkward days of menses. This is a necessity, whether we like it or not, but to some it is even more disturbing as they have irregular menstrual bleeding that might be accompanied with pain and extreme weakness.

Most of the time it is not just an apparent imbalance but a result of structural, hormonal and emotional disturbances occurring in the female body. Let’s take a look at each in detail in order to understand it better and manage it accordingly.

Menstrual bleeding is unique for every individual. Normal menstrual cycle is 21–35 days in duration, with bleeding lasting an average of 5-7 days. Deviations from this range is categorized as abnormal. We will be covering various menstrual irregularities in a series of articles here on

Menorrhagia/Hyper menorrhea

Heavy bleeding that interferes with your normal routine, that might accompany pain and fatigue can be termed as heavy menstrual bleeding or menorrhagia. To explain it’s more than one pad/tampon completely soaked in less than an hour for several hours consecutively and specifically it is blood loss of greater than 80 ml that constitutes menorrhagia.

According to recent research, one in every five women between the age of 30 and 50 has complained of heavy bleeding. Women at the extremes of ages i.e. menarche (near puberty) and menopause (near old age) are more likely to experience heavy bleeding, as their cycles are more influenced by hormonal changes in the body. Other situation when hormones can be imbalanced is pregnancy, so after child birth, periods tend to get heavy.


Most of the time there is no apparent reason for abnormality in menses and women just start noticing an increase in the need to change pads/tampons more often. They may see spots on their clothes, start finding clots on pads and may start feeling lethargic (as new blood formation takes time, leaving a person anemic for a while) also these findings may take a while before getting noticed. However, early approach towards diagnosis of any disease is more beneficial as this heavy bleeding is far more disastrous than just leaving the female weak.


Proper diagnosis of why the woman is having heavy bleeding shows the way to start treatment appropriately.

Most of the times there are regular hormonal imbalances such as ones expected at puberty, menopause and pregnancy. One can wait to grow out of it, but taking proper care throughout is important – by eating healthy and taking multivitamins so the effects of anemia are decreased.

Dysfunctional Uterine Bleeding (DUB) is the most common cause of abnormal heavy menstrual bleeding, cause of which is not known but the hormonal changes can make a person suffer to a major extent.

Imbalanced hormones, other than DUB can be because of drugs or other medical disorder such as that of thyroid, liver or kidneys  but it has to be properly investigated by the doctor and has to be managed accurately.

Use of IUCD (Intra Uterine Contraceptive Device) is also a cause of heavy menstrual bleeding so one should be aware of how to use it and its consequences. However, there is a special hormone-releasing IUCD called Levonorgestrel intrauterine system (LNG-IUS)   which can actually treat heavy menstrual bleeding.

Mass/tumor is a cause of physical as well as hormonal imbalance, early detection avoids major disasters later on.

Pregnancy, whether normal or ectopic (implantation of future baby at abnormal location) as well as miscarriages are other common causes of menorrhagia or hyper menorrhea.


Your doctor might investigate you by carrying out a thorough physical examination of vagina, cervix or uterus. Many doctors also order some blood tests to determine level of anemia and to detect any bleeding disorder. Ultrasound and hysteroscopy (viewing of uterus through an inserted camera) might be needed if a physical abnormality is suspected. And to detect inflammation or abnormal growth internal swab or endometrial sampling might also be performed, in which physician will take sample of endometrium and assess in laboratory.

Treatment Options

Other than DUB which has no apparent cause of menorrhagia, the different underlying diseases need to be treated accordingly to minimize heavy menstrual blood loss.

Drugs and medication

The most convenient option is use of drugs one can get over the counter – painkillers like ibuprofen or prescribed anti-inflammatory painkillers such as mefenamic acid or naproxen. Other drugs that can be prescribed by your doctor are contraceptives, used as IUCD, injections or implants.


Though not the first line of treatment, surgery is an option when drugs dont work. Surgical treatments include endometrial ablation/resection which involves removal of much of lining of endometrium (but is potentially contraceptive) excision of the mass causing abnormality (e.g. fibroids).

Hysterectomy (complete removal of uterus) is the last option for treatment of menorrhagia.

There are many treatment options are available to relieve from the state of menorrhagia when menstrual bleeding tends to get heavier, depriving a woman from her routinely activities. So keep track of menses and its irregularities to be aware of the need to treat it before it gets worse.


About the author:

Dr. Madiha Masood is the mother of four children, two of which are twins. She has previously worked as an obstetrician/gynecologist at Lady Dufferin Hospital and has now undertaken the task of simplifying health issues in accordance with Islamic values.


We dont always discuss them, but knowing and treating menstrual problems/irregularities in time is the first step in making sure that women can lead a happier, healthier, more productive life. Do you have any concerns you would like to share with other moms? Drop by our forums for more information and discussions.