Heavy menstrual bleeding is more than an inconvenience in adolescents: it often leads to significant medical complications, in addition to disruptions in quality of life. It can be a real problem.
The loss of blood often makes women feel weak and lack the energy to do things. They may have period pain too, and it’s annoying to have to change tampons, sanitary pads or period underwear so often.
Heavy monthly bleeding should not be ignored, though, as there are a number of other possible causes of significant bleeding during menstruation. It requires speaking up and treatment.
Professor Hadijat Raji, a consultant obstetrician and gynaecologist at the University of Ilorin Teaching Hospital, declared that most women will know what their normal bleeding pattern is like.
According to her, “Normally when you’re menstruating, you’re not supposed to have clots in the menses. So by the time you’re bleeding, you can see that there are clots in the menses. That bleeding is excessive.”
“By the time you’re bleeding, you can feel the blood come out. We call that flooding. You can actually feel blood coming out from the vagina. That means that you’re bleeding excessively.”
“Also, if the frequency of changing of pads becomes higher, for example, if you used a pad for maybe four or five hours before, and now you’re using one pad in two hours, then that shows you that you’re bleeding excessively. Or if you’re feeling excessively worn out during your menses, then you know that this is excessive bleeding.”
Prof. Raji declared that heavy menstrual bleeding could be for many reasons, including conditions affecting the womb or ovaries, such as polycystic ovary syndrome, fibroids, endometriosis, adenomyosis and pelvic inflammatory disease. Furthermore, in rare cases, heavy periods can be a sign of womb cancer.
“In our environment, uterine fibroids are one of the common causes of excessive bleeding during menses,” she added.
Prof. Raji stated that treating some of the causes of heavy monthly bleeding could help them avoid developing anaemia from iron and red blood cell loss, which can lead to weakness and exhaustion. It can also cause severe pain and significantly disrupt daily life, including studies and work.
Additionally, having to change sanitary pads, tampons or period pants frequently may be irritating.
While heavy bleeding can make it tough to take part in normal daily life at times, there are treatments to help, including medication, hormonal contraceptives and surgery.
Haleema Shakur-Still, professor of Global Health Clinical Trials and the co-director of the London School of Hygiene & Tropical Medicine’s Clinical Trials, said tranexamic acid is a treatment option also for some women with heavy menstrual bleeding.
Professor Shakur-Still spoke at the 8th international and scientific conference of the Association of Fetomaternal Medicine Specialists of Nigeria (AFEMSON) with the theme “Contemporary Research in Fetomaternal Medicine” in Ibadan.
“Menstrual bleeding is something that’s totally ignored. Tranexamic acid will reduce the loss of about 40 to 50 per cent of menstrual blood from each cycle, leading to an 8-ml reduction per cycle. And it can improve health-related quality of life and participation in women with high and heavy menstrual bleeding,” she added.
It’s the standard care and first-line treatment for heavy menstrual bleeding. And it’s endorsed by a lot of national and international guidelines. And there’s a recommended dose of about 3-4 grammes per day for 4 to 5 days for each menstrual cycle.
She stated that the use of tranexamic acid in the treatment of heavy menstrual bleeding is still fraught with many misconceptions. A lot of the myths come from the belief that there’s an increased risk of a circulating blood clot that gets stuck and causes an obstruction.
Professor Shakur-Still states, “We’ve never seen an increased risk of thromboembolic events—a circulating blood clot that gets stuck and causes an obstruction—having conducted trials in very high-risk patients, with over 100,000 patients being randomised into surgical, trauma, and postpartum situations.”
“There’s also a belief that it can cause blood in urine. I don’t think we’ve seen a single case in any of our trials where it’s been reported as an adverse event.”
“So a lot of the side effects that are mentioned on the drug monograph, or what we call a summary of product characteristics, were there from when the drug was tested in its early life. And none of the data that has become available has been incorporated into an updated drug monograph.”
However, Professor Shakur-Still said women who have severe menstrual bleeding may find it difficult to take tranexamic acid if they are unaware that they are experiencing heavy bleeding.
“Because we don’t talk about it, so women will automatically accept their bleeding as normal even when it is heavy. But even among women, we don’t talk about what normal bleeding is. Not many know what normal bleeding is.”
“So women are bleeding; they’re losing blood every single month, and yet we have an effective treatment that they’re not receiving. We know that everyone thinks of dietary aspects of anaemia, and we ignore treatment with tranexamic acid.”
To guarantee that the lady has a healthier pregnancy, she declared that it is crucial to intervene to prevent anaemia by minimizing blood loss. If women with anaemia are treated before they become pregnant, it ensures a better outcome with pregnancy.
@ Vanguard Newspaper
