Heavy & Irregular Periods in Gurugram

Modern guidance defines heavy menstrual bleeding as blood loss that interferes with your physical, emotional, social or material quality of life. There is deliberately no number attached. The old threshold of 80 millilitres per period was abandoned because it is impractical to measure and described the problem poorly. Practical markers that correlate well with genuinely heavy loss are soaking through a pad or tampon within an hour repeatedly, passing clots larger than about two and a half centimetres, needing double protection, and getting up at night to change.

Eight days or fewer. Bleeding that regularly lasts longer than eight days is called prolonged menstrual bleeding and is worth investigating, even if the daily volume feels manageable.

A normal cycle arrives every 24 to 38 days, counting from the first day of one period to the first day of the next. Closer than 24 days is frequent bleeding; further apart than 38 days is infrequent bleeding. Both point somewhere different from heaviness.

Up to about seven to nine days between your shortest and your longest cycle over a year. Beyond that the cycle is classed as irregular, which usually raises a question about ovulation rather than about the uterus itself.

It is the international classification of causes of abnormal uterine bleeding. PALM covers the structural causes you can see: Polyp, Adenomyosis, Leiomyoma (fibroid) and Malignancy or hyperplasia. COEIN covers the non-structural ones: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic and Not otherwise classified. It exists because before it, anything without an obvious cause was called a hormonal imbalance and treated identically in everyone.

Usually not. Cancer and pre-cancer are the least common of the nine causes in women of reproductive age. But they are the reason bleeding is investigated rather than simply medicated, and the risk rises with age, with years of irregular cycles, with PCOS, with obesity, with tamoxifen, and above all with any bleeding after the menopause.

It needs assessing promptly. Post-menopausal bleeding is benign in the large majority of women, but it is the one symptom on this page that should not be watched or medicated. Ask for an appointment within a week or two, and expect the lining of the uterus to be assessed at hysteroscopy rather than blind.

Occasional spotting mid-cycle is common and often harmless. Bleeding that keeps happening between periods points at the cavity of the uterus, most often a polyp or a fibroid bulging into it, and sometimes at the cervix. It is a looking problem rather than a medicating problem, and it responds poorly to more tablets.

Bleeding after sex is a cervical question rather than a heavy-periods question. The cervix needs examining directly and cervical screening needs to be up to date. It is not a symptom to sit on, even when everything else about your periods is normal.

Not always, and not always first. An ultrasound is the right first look where a fibroid is large or the examination is difficult. Where the question is specifically about the cavity, hysteroscopy is what guidance points to, because it sees directly and can treat in the same sitting. Scans are arranged by referral from the clinic and timed to the right part of your cycle, since a scan in the second half of the cycle can hide a polyp completely.

Not routinely. Guidance specifically advises against routine thyroid and hormone testing in heavy menstrual bleeding. They are worth doing where the story points there, particularly with irregular timing or features of PCOS, and not as a reflex panel.

In India, yes, and we check it. UK guidance advises against routine ferritin testing, but that advice was written for a population where baseline iron deficiency is uncommon. With 57% of Indian women of reproductive age anaemic, and iron stores emptying well before haemoglobin falls, a normal haemoglobin here does not mean your iron is fine.

Yes, and it is the commonest cause of iron deficiency anaemia in women of reproductive age. Tiredness out of proportion to your life, breathlessness on stairs, dizziness on standing, palpitations, cold hands and difficulty concentrating are the usual symptoms, and they often creep up slowly enough to be mistaken for normal.

Tablets are enough for most women, provided they are taken properly: the right dose, with vitamin C, away from tea, coffee, calcium and antacids, and continued for about three months after the haemoglobin normalises so the store refills. Alternate-day dosing is often better absorbed and better tolerated than daily. Intravenous iron is reserved for genuine intolerance, poor absorption or a need to correct quickly, and can be given at the clinic where it is appropriate.

Where the cavity of the uterus is normal or nearly so, guidelines name the hormonal coil as the first treatment to consider, because it reduces menstrual blood loss more than any tablet. If you would rather not have a coil, tranexamic acid, anti-inflammatory tablets, the combined pill or cyclical progestogens are all reasonable alternatives.

It is a non-hormonal tablet taken only on the heavy days. It does not affect fertility, does not alter your cycle, and does not contain hormones. It reduces blood loss by roughly a quarter to a half. It is avoided in women with a history of blood clots and is one of the most commonly under-offered treatments for heavy periods.

Substantially more than any tablet. In studies it reduces menstrual blood loss by the largest margin of any medical treatment, and many women end up with very light periods or none at all. It also treats period pain in many women. In the Indian setting we plan on five years per device.

They are widely prescribed in India and are among the weaker options for heaviness specifically. They are more useful when the problem is irregular timing rather than volume. If cyclical progestogens are all that has been offered and they have not worked, that is a reason to ask about the other options rather than to repeat the course.

When a specific structural cause has been identified and treating it will treat the bleeding, or when medical treatment has been genuinely tried and has not worked, in a woman whose symptoms are affecting her life. Surgery aimed at a cause somebody has actually identified works far better than surgery aimed at bleeding in general.

It destroys the lining of the uterus and is an option for women who have completed their family and whose uterine cavity is normal. It is quick and effective, but it is not a contraceptive and pregnancy after ablation is dangerous, so contraception continues afterwards.

Almost certainly not. Hysterectomy is the last option on the list, not the first. It is genuinely the right answer for some women, but there are seven things that come before it, and a second opinion before consenting to one is entirely reasonable and never taken as a slight.

Only partly, and it is no longer the recommended approach. A blind sampling of the cavity misses a substantial proportion of polyps and can leave a lesion behind entirely. Current guidance is that sampling should be done at hysteroscopy, under direct vision. A normal blind biopsy is not the same as a normal cavity.

It is worth considering if your periods have been heavy since the very first one, or if there is easy bruising, frequent nosebleeds, bleeding after dental work or a family history. Von Willebrand disease is the commonest. Testing is recommended for that specific pattern rather than for everyone with heavy periods.

Heavy bleeding together with genuinely severe pain, often in a woman in her late thirties or forties, is the classic picture of adenomyosis, where lining tissue grows into the muscle wall. It is frequently missed for years and frequently mislabelled as fibroids. Endometriosis is the other possibility worth naming.

Very possibly. PCOS is one of the commonest reasons for cycles that arrive unpredictably rather than heavily, because ovulation is not happening regularly and the lining builds up unopposed before shedding. Thyroid disease, the years around the menopause and the first years after periods start do the same thing.

It often is, because cycles stop ovulating reliably in the years before the menopause. But it is also the age at which the lining should be assessed rather than assumed, so perimenopause is a diagnosis to arrive at rather than to start with. At 45 and over, guidelines say the lining should be sampled where bleeding persists or treatment has not worked.

If you have bleeding after the menopause, bleeding after sex, bleeding in a possible pregnancy, or you are soaking through protection hourly and feeling faint, do not wait. Otherwise, two or three cycles tracked on paper is a useful thing to bring, and there is no harm in being seen before that if it is affecting your life.

A record of two or three cycles if you have it, with dates, duration and which days were genuinely heavy. Any previous scan or blood reports, including old ones, since comparing over time says more than a single result. And the names and doses of anything you have already tried, with how long you took it for.