Q. How will I know that my menstrual bleeding is heavy?  
A. 30% women do not recognize heavy period bleeding. Passing of clots, prolonged bleeding for over a week and flooding are rough indicators of heavy bleeding. The most predictive indicator however is blood hemoglobin estimation. Normal values should be between 12 and 14gm%.

Q. When does heavy bleeding need treatment? 
A. When heavy bleeding is significant enough to cause anemia or severely interferes with one’s quality of life it should be treated. Abnormal heavy bleeding may need investigation and treatment when suspected to be associated with malignancy.

Q. What could be the causes for heavy bleeding?
A. Hormonal imbalance is one of the most common reasons for heavy bleeding. Besides this, tumors of the uterus, infections, endometriosis, malignancies could also cause heavy bleeding.

Q. What tests need to be done to find out the cause of heavy bleeding?
A. Simple haemglobin estimation is useful to assess the severity of the situation. Thyroid function tests and an ultrasonography done through the vaginal route are useful assessment tools. Sometimes a biopsy of the inner uterine wall may be required to find out the cause.

Q. What are the principles of treating heavy bleeding?
A. The principles are to find out the cause. Start appropriate treatment to arrest the bleeding and give medicines to boost up the hemoglobin.

Q. What medicines are commonly prescribed for heavy bleeding?
A. Medicines may be hormonal or non-hormonal. Among the non-hormonal medicines tranexamic acid is the most popular and effective. A variety of hormonal agents may be offered ranging from progesterone derivatives to oral contraceptive pills.

Q. What treatment, other than a hysterectomy, may be offered for heavy menstrual bleeding?
A. If the bleeding is due to hormonal imbalance then treatment may consist of a Mirena coil, which is a hormonal device kept in the uterus to control bleeding locally. It is very effective and cuts down the necessity of a hysterectomy in many cases. For women who have completed their family, treating the inner uterine lining with heat (balloon ablation) or x-rays (radiofrequency ablation) often controls bleeding.