Question and Answers (Q&A)

I HAVE been bleeding a lot during my periods recently. It is quite excessive, sometimes soaking five sanitary pads in a day, and I am very worried. Is this normal?

Normal vaginal bleeding occurs when you have your period, or menstruation. It is a result of normal cyclic hormonal changes within your body. It usually occurs at 28 day intervals, though for some women, this may be longer or shorter.Your period begins somewhere in your teens and the cycles end at menopause, which usually occurs at the age of about 51 (on average).
Anything other than this is considered abnormal vaginal bleeding. Abnormal vaginal bleeding is also bleeding that occurs in inappropriate amounts – either too much blood or too little blood.
Your periods are caused by a process called ovulation, where one of your ovaries releases an egg every month. This process is controlled by the cyclic flux levels of your hormones, oestrogen and progesterone.

What types of abnormal menstruation are there?
We can divide abnormal bleeding into either duration or amount.
If you have your period for too long, this is called hypermenorrhoea (hyper = more). If it is too short, it is called hypomenorrhoea (hypo = less). Note that different women have different period lengths, so if you notice a change in your usual pattern, it’s considered abnormal.
Then the interval between your menstrual periods can be abnormal. If it occurs too frequently, it is called polymenorrhoea (poly = many). If it occurs too infrequently, it is called oligomenorrhoea (oligo = seldom or scarce).
If your interval varies from one cycle to the next, such as if you have it between 21 days for one period, and 35 days between the next, this is called metrorrhagia.
As for the amount, if you have too much bleeding, this is called menorrhagia, and if it is too little bleeding, it is called hypomenorrhoea.

Why do some women have excessive period bleeding? Is it because they have too much hormones?
Heavy menstrual bleeding, menorrhagia, is classified as having greater than five tablespoons of blood per month. This can be hard to measure if you are wearing sanitary pads or tampons! But 10% of the menstruating women in the world get this.
Some causes include:
  • Dysfunctional uterine bleeding – the cause of this is unknown
  • Fibroids in your uterus (womb) – this is a benign tumour of your womb’s smooth muscle tissue
  • Polyps in the lining of your womb (tiny benign growths that protrude from a stalk)
  • Intrauterine contraceptive devices
  • General disorders affecting multiple organs - Hypothyroidism, bleeding or clotting disorders
  • Womb cancer (this is not a common cause of menorrhagia)
    Therefore, if your periods are very heavy, it’s always best to check it out with a gynaecologist.

    I know a friend who has very infrequent periods. She is trying to conceive and it’s proving very difficult. What are the causes pf infrequent periods?
    Irregular menstrual periods (metrorrhagia) may be caused by polyps in the cervix, infections of the womb’s lining and usage of oral contraceptives.
    Often, there is no identifiable cause. So your friend should go for a check-up. If there is no cause, this is an unfortunate symptom she has to live with. Fear not, there are many ways to determine when she ovulates, and therefore, can conceive.
    A colleague of mine has menstrual periods which are too frequent. She would be having one for seven days, then it would stop for six days. Then it would begin again! It would be associated with a lot of pain. This is not normal, right?
    No. This is polymenorrhoea, which can be caused by sexually transmitted diseases, such as infections by chlamydia or gonorrhoea. This is called pelvic inflammatory disease. Another frequent cause is endometriosis. After everything is investigated and all the known causes are ruled out, your polymenorrhoea can be attributed to dysfunctional uterine bleeding.
    Again, fear not. The symptoms can be relieved and regulated by oral contraceptives (to ensure your periods become controlled and regular) as well as painkillers for the period pains (dysmenorrhoea).

    My friend has been having a
    little vaginal bleeding in between periods. Is this caused by sexual intercourse?
    Depends on how traumatic the sexual intercourse is! But women who are ovulating normally can experience light bleeding (called “spotting”) between menstrual periods, caused by oral contraceptive pills or intrauterine devices.
    Stress can also cause this because stress may lead to fluctuations in your hormone levels.
    In addition, any factor that can cause abnormal periods can also lead to bleeding between periods. It’s always best to go for a check-up.


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