If your period is heavy enough to disrupt your life, it’s not something you have to suffer through in silence. We spoke to consultant obstetrician and gynaecologist Dr Premitha Damodaran about heavy menstrual bleeding (HMB), what signs to look out for, and why it’s so important to get help.
WORDS LIM TECK CHOON
 FEATURED EXPERTDR PREMITHA DAMODARAN Consultant Obstetrician and Gynaecologist Pantai Hospital Kuala Lumpur |
For some women, periods aren’t exactly a walk in the park.
Yet, there’s a difference between a bad period and one that is heavy enough to affect your daily life.
WHAT IS CONSIDERED HEAVY MENSTRUAL BLEEDING?
Heavy menstrual bleeding or HMB occurs when your period is so heavy that it interferes with your normal routine.
Signs That You May Have HMB
According to Dr Premitha Damodaran, signs you might be dealing with HMB include:
- Bleeding for more than 7 days
- Needing to change pads or tampons every 2 hours or more frequently
- Needing double pads on heavy days
- Waking up at night to change pads or tampons
- Needing to wear menstrual diapers
- Passing blood clots that are bigger than a 20-sen coin
- Having to plan your life around your period, which can lead to missing work, school, or social activities
- Constantly feeling weak, tired, or drained
“Many women normalize these symptoms, but they are not a normal part of being a woman,” stresses Dr Premitha.
“If your period is affecting your daily life or health, it’s time to seek help,” she adds.
WHY YOU NEED TO SEEK HELP FOR HMB
Ignoring heavy periods isn’t just uncomfortable — it can lead to bigger problems.
Dr Premitha explains that HMB affects more than just your physical health.
HMB Lowers Your Quality of Life
- Experiencing HMB means losing a lot of blood every month.
- When that happens, Dr Premitha explains that your body loses red blood cells and iron, both of which are needed to carry oxygen around your body.
- If your body can’t replace the lost iron through meals or supplements, it leads to iron-deficiency anaemia.
- That’s why people with HMB often feel tired, dizzy, or breathless, which are classic symptoms of anaemia.
HMB Could Be a Sign of an Underlying Health Problem
Dr Premitha shares that, to determine why a woman might have abnormal bleeding, doctors often use a system called PALM-COEIN (see below).
HMB Can Takes a Toll on Your Mental and Social wellbeing
- HMB can make it harder for the affected woman to work, study, or socialize.
HMB Can Increase Your Financial Strain
- If left untreated, HMB could lead to more serious issues that require more expensive medical procedures.
- “One woman I saw recently had been bleeding for months and was too scared to seek help,” shares Dr Premitha. “When she finally came in, her haemoglobin was dangerously low. Don’t wait until it’s an emergency!”
- High prevalence of HMB, if left untreated, can also strain the national health system.
HOW DOCTORS CAN HELP YOU IF YOU HAVE HMB
“HMB is typically not curable, but it can be managed,” Dr Premitha says, adding that with proper management, women with HMB can still lead active, normal lives.
Determining the Cause
“The first step is finding out what’s causing it,” says Dr Premitha.
- This usually involves a Pap smear and/or an ultrasound.
- Sometimes, the doctor may obtain a small sample of endometrial tissue to be sent to the laboratory for investigation.
The PALM-COEIN System
Doctors use a system called PALM-COEIN to figure out the cause, which could range from polyps and fibroids to hormonal imbalances or clotting disorders.
- PALM: Things you can physically see or find in the uterus.
- COEIN: Things you can’t easily see but affect how the body works.
P — Polyp
- Small, soft growths on the inside lining of the uterus.
- They are usually non-cancerous but can cause heavy or irregular bleeding.
A — Adenomyosis
- When the tissue that normally lines the endometrium (the inner epithelial layer of the uterus) starts growing into other areas in the muscular wall of the uterus.
- These areas of endometrial tissue will ‘bleed’, make periods heavier and more painful.
L — Leiomyoma
- The presence of fibroids.
- Fibroids are non-cancerous lumps made of muscle and fibrous tissue that grow in or around the uterus.
- Fibroids can cause heavy bleeding, pressure, or pain.
M — Malignancy and premalignancy (hyperplasia)
- Malignancy refers to the presence of cancer of the uterus
- Premalignancy or hyperplasia refers to changes in the womb lining that could turn into cancer.
- Both malignancy and premalignancy can cause unusual or heavy bleeding.
C — Coagulopathy
- Blood clotting problems; blood doesn’t clot properly, leading to heavier bleeding.
- Some people are born with these conditions such as von Willebrand disease that can lead to heavy bleeding during menses.
O — Ovulatory dysfunction
- When your ovaries don’t release eggs regularly.
- This messes up your hormone levels and can cause unpredictable, heavy, or long-lasting periods.
E — Endometrial
- The endometrial lining of the uterus doesn’t respond to normal hormone signals properly, even if your hormone levels and ovulation are fine.
- This can cause heavy bleeding.
I — Iatrogenic
- Bleeding caused by medications or devices, like blood thinners, certain contraceptives, or treatments for other health issues.
N — Not yet classified
- Causes that don’t fit into any of the above categories.
Doctors use the PALM-COEIN system as a structured way to figure out why a woman is having HMB and other causes of abnormal bleeding of the uterus. Think of it as a checklist to help doctors analyze the situation systematically and thoroughly.
Dr Premitha explains that the doctor starts with a woman’s symptoms, medical history, age, and risk factors to narrow down the likely causes.
Based on that, they decide with PALM-COEIN as a guide as to which tests, scans, or examinations that the woman should undergo.
- For example, the ultrasound test for a woman has heavy periods and severe cramps shows the presence of fibroids (leiomyoma). The doctor can then address the issue accordingly.
- If nothing obvious shows up on the ultrasound scan, they can use the woman’s symptoms to check for the next items on the PALM-COEIN system, such as coagulopathy (“C”) or hormone imbalances (“O”) through blood tests.
- It’s not about testing every letter for every patient — it’s about using the system to guide smart, focused decision-making!
Treating the Root Cause
Once they know what’s going on, the doctor can then tailor a management plan that will best suit the affected person’s health status, lifestyle, and other unique factors.
Options that can be considered include:
- Medications, such as like tranexamic acid to reduce bleeding and non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief
- Iron supplements to treat iron-deficiency anaemia
- Hormone therapy, such as like progesterone tablets or an intrauterine device (IUD), which works directly in the uterus; Dr Premitha recommends the IUD method because it acts directly in the uterus
- Oral contraceptives are another option to regulate hormones
- Surgical procedures may be needed needed for issues such fibroids, polyps or, cancer
“The priority is to stop the bleeding, correct iron levels, and then manage future periods, explains Dr Premitha.
She also assures us that not every case of HMB needs surgery.
“Many can be controlled with medication and simple interventions,” she says.
A GENTLE REMINDER
“If your period is affecting your health, mood, work or social life, it’s not something you should just put up with,” reiterates Dr Premitha.
“There’s no need to suffer in silence,” she adds. “Help is available, and the sooner you get it, the better you’ll feel.”
So, if this sounds like you or someone you know, don’t hesitate. See a doctor and take back control of your health and life!
| A Note about OTC Products There are many over-the-counter products at the pharmacy, which one can purchase without a doctor’s prescription, such as heating pads for menstrual pain and OTC painkillers. However, these products do not address the root cause of HMB, instead providing only temporary relief from symptoms. Hence, it’s best to consult a doctor when one’s HMB affects their ability to lead normal, happy lives. |
| This article is part of our series on tips and advice on matters related to a woman’s health. |
