HEAVY MENSTRUATION FLOW

Heavy menstrual flow medically referred to as menorrhagia is a form of bleeding that can make a woman feel uncomfortable during the menstrual cycle. It can be accompanied with dysmenorrhea.

Heavy bleeding doesn't necessarily mean there's anything seriously wrong, but it can affect a woman physically and emotionally, and disrupt everyday life.

SIGNS THAT SHOW YOU HAVE HEAVY MENSTRUAL FLOW

You have heavy or excessive menstrual bleeding if:

·         you change pads or tampons 3-5 times per day and it was not so before

·         blood leaks off the pad or tampon to stain your clothes or bedsheet or seat

·         you need to use tampons and towels together

What causes heavy periods?

Menorrhagia has no real cause most of the time but we do know that some conditions or medications do cause or increase the risk of menorrhagia.

Conditions that can cause heavy bleeding include:

·         pelvic inflammatory disease (PID) – UTI (the womb, fallopian tubes or ovaries) that can cause pelvic or abdominal pain and bleeding after sex or between periods

·         polycystic ovary syndrome (PCOS) – a common condition that affects how the ovaries work; it causes irregular periods, and periods can be heavy when they start again 

·         fibroids – non-cancerous growths that develop in or around the womb and can cause heavy or painful periods

·         adenomyosis – when tissue from the womb lining becomes embedded in the wall of the womb

·         endometriosis – when small pieces of the womb lining are found outside the womb, such as in the fallopian tubes, ovaries, bladder or vagina (although this is more likely to cause painful periods)

·         Hypothyroidism (underactive thyroid gland) – where the thyroid gland doesn't produce enough hormones, causing tiredness, weight gain and feelings of depression 

·         blood clotting disorders

·         cancer of the womb (although this is relatively rare)

·         an IUD (intrauterine contraceptive device, or "the coil") – this can make your periods heavier for the first three to six months after insertion

·         anticoagulant medication (drugs that prevent blood clots)

·         some medicines used for chemotherapy

Treating heavy periods

You may not need treatment if a serious cause isn't suspected, or the bleeding doesn't affect your everyday life.

Read more here for treatment options

Bleeding after childbirth

After having a baby, heavy vaginal bleeding, known as lochia, is very common and completely normal. It's your body's way of getting rid of the womb lining after you've given birth.

The bleeding can last from two to six weeks, and the blood may come out quickly, or slowly and evenly.

The amount of blood loss varies between women. If you've had a caesarean section, you'll also have some bleeding as the womb lining sheds, although it may be lighter than if you'd had a vaginal birth.

You'll need to use thick sanitary pads to start with while the bleeding is at its heaviest.

Once the flow settles down, you can switch to using normal sanitary pads. Always wash your hands before and after changing your pad.

Don't use tampons for the first six weeks after the birth as it increases the risk of your womb becoming infected.

The colour of the blood will also change in the days and weeks after childbirth. It'll be bright red for the first few days and may contain small clots.

As the bleeding becomes less heavy, the colour of the blood will lighten, becoming pinkish and more watery.

It's important to make sure you get plenty of rest and don't overdo it during this time. It could be a postpartum haemorrhage caused by a piece of placenta still inside your womb. You may need antibiotics or an operation to remove the piece of placenta.

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ALERT: WHY YOU MUST TREAT YOUR HYPERTENSION

Stroke

the remote control of all body parts

High blood pressure causes your arteries to damage or clog more easily, putting you at high risk for a stroke

When a blood vessel in the brain is blocked or damaged, that part of the brain does not get the blood and oxygen it needs. So brain cell or body cell dies as a result of oxygen deprivation if the partial pressure of oxygen falls below normal. This can cause partial paralysis or total paralysis depending on part of the brained involved. This results in loss of ability to control movement and body functions, speak, remember things, or think clearly. This means there is impairment of cognition.

Heart and artery damage

the life machine of every man

High blood pressure can cause microscopic tears in your artery walls. These tears turn into scar tissue. The scar tissue creates rough walls, collecting cholesterol, platelets, fats, and plaque. This narrows and hardens the arteries

Damaged and hardened arteries can limit the amount of blood your organs get, causing them to not work as well as they should

Pieces of the deposits left in the arteries due to scar tissue can break off, causing blood clots that flow through the bloodstream until they get stuck in a small space. This can block the blood supply to part of your heart or brain, causing a heart attack or stroke

The heart has to work harder to pump blood through damaged arteries. This can make it thicker and larger. The damaged heart works less effectively, so the rest of your organs may not get all the blood they need

When the heart doesn't get as much blood as it needs, you could develop angina—uncomfortable pressure, fullness, squeezing, or pain in the center of the chest. People with angina usually feel their symptoms when walking up a hill, climbing stairs, or doing other sorts of physical activity

Narrowing of the arteries to your legs, stomach, arms, and head, called peripheral artery disease (PAD), can cause cramping, pain, or tiredness mostly in the leg and hip muscles. People with PAD also have a much higher risk of heart attack or stroke

Kidney damage

the purifier of the body

Uncontrolled HTN can exert much pressure on the kidney capillaries which can lead to nephropathy. At initial time, HTN can results of hyperfilteration at the glomerulus. This can lead to essential blood electrolyte such as albumin and other proteins being lost in the urine. Damage to kidney is a double damage to the body because the kidney gradually loses it function of osmoregulation i.e regulation of water and salt balance, elimination of waste products of metablosim and secondly the body then loses another Blood pressure control mechanism as damaged kidneys are also unable to help your body regulate its own blood pressure which normal kidneys do.  So uncontrolled HBP can lead to kidney failure

Vision loss

the light of the body

High blood pressure causes much pressure to the delicate blood vessels (capillaries) in the eyes and damages them. This leads to retinopathy or impaired vision.

Glaucoma is an eye disease that is often associated with elevated intraocular pressure, in which damage to the eye (optic) nerve can lead to loss of vision and even blindness if the cause was not properly addressed.

So HBP is the chief risk factor for glaucoma which is the chief cause of permanent blindness in the world.  So lowering your blood pressure will do good in preventing damage to blood vessels in the eye so treating.

Also, brain damage caused by stroke can also lead to permanent vision loss. 

Hypertensive crisis

body organs

This is HBP at the extreme (SBP of 180 or higher /DBP of 110 or higher). The writer here have taken a BP of 216/140 mmHg. It may even be as high as 240/150. This is hypertensive emergency and the patient should be admitted right away because any further negligence may lead to comorbidities and synchronous organ failure within few days.

It may be accompanied by a severe headache, tachycardia, dyspnea or shortness of breath, nosebleed, and/or anxiety disorder.

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MANAGEMENT OF HYPERTENSION

The first step to managing hypertension is lifestyle modification. If the BP is not responding well to lifestyle modification, the drug therapy will be the next step. Below are classes of drugs used listed, your healthcare provider will choose the one appropriate for you.

Calcium channel blockers,  CCBs

Calcium channel blockers can also be grouped into several classes depending on their structural composition

Calcium channel blockers reduce blood pressure by widening your blood vessels.

Common examples are amlodipine, nicardipine, felodipine and nifedipine, diltiazem , verapamil. It should be noted that verapamil and diltiazem have more affinity for calcium channels in the heart.

Possible side effects include headaches, swollen ankles and constipation.

Beta-blockers

Beta-blockers can reduce blood pressure by reducing the contractility of the heart thereby making your heart beat more slowly and with less force.

They may have devastating effect in patient with left ventricular heart failure and should not be given in this case.

They are also contraindicated in hypertensive asthmatic patients because they worsen asthma by their induced bronchoconstriction via beta receptor in the respiratory pathway

Common examples are timolol, propanolol, atenolol , bisoprolol and metoprolol.

The beta-antagonists that are still very much in use are those ones that are selective.

Possible side effects include decreased libido, dizziness, headaches, tiredness, and cold hands and feet.

ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure by dilating blood vessels especially the peripheral vasculatures. ACE inhibitors are very useful in patients with co-morbidity as well preventing end-organ damage which is mostly associated with HTN

Common examples are enalapril, lisinopril, perindopril and ramipril.

The most noticeable side effect is a persistent unproductive cough. Other possible side effects include headaches, dizziness and a rash.

Angiotensin-2 receptor blockers (ARBs)

ARBs work in a similar way to ACE inhibitors. They're often recommended if ACE inhibitors cause troublesome side effects.

ARBs have no or less effect on bradykinin level and so are not likely to dry cough associated with ACE inhibitors.

Common examples are candesartan, irbesartan, losartan, valsartan and olmesartan.

Possible side effects include dizziness, headaches, and cold or flu-like symptoms.

ACE inhibitors and ARBs can be grouped together as RAAS which means rennin-angiotensin-aldosterone system which highlights the mechanism of their action.

Diuretics

Diuretics work by removing excess salt and water from the body through urine. There exist different types of diuretics so your healthcare provider will prescribe the one appropriate for you after adequate assessment.

Common examples are ,hydrochlorthiazide HCT, moduretic, indapamide and bendroflumethiazide.

Possible side effects include postural hypotension, increased thirst, and frequent urination

 Hypokalaemia and hyponatraemia are common so electrolyte level must be monitored.

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Questions and Answers on Hypertension

What is Hypertension?

Hypertension is a sustained high blood pressure. It means if take your blood pressure on three or several occasions and it remains high, you might be having hypertension otherwise called High Blood Pressure.

You may have high blood pressure and may not have hypertension but if you keep on having high blood pressure repetitively, then you are likely hypertensive.

What is Blood Pressure BP?

Blood pressure (BP) is the pressure or force which the blood exerts on the blood vessels (‘the pipes that carries blood to and fro through the heart) as it flows through them.  An elementary Physics students will know that a liquid passing through a hollow pipe does exerts pressure on the inner surface of the pipe. Imagine the heart as a pumping machine. Any pumping machine will use a force or pressure to pump liquid. Blood pressure can also be defined as the force with which the heart pumps blood through the blood vessel. You have high blood pressure when the force of pumped blood is too high against the arteries.

How do I know if I have high Blood Pressure?

Visit a health professional and demand your blood pressure taken. He/she will use a blood pressure-taking instrument called sphygmomanometer to measure your BP.  You can take your BP by yourself if you have the instrument. Read about self blood pressure monitoring.

What is the normal BP value?

Blood pressure value exists as two readings known as systolic blood pressure SBP and diastolic blood pressure DBP. The blood pressure is written as SBP/DBP mmHg, e.g 97/72 mmHg simply read as “97 over 72”. The first number, called systolic blood pressure, measures the pressure in your blood vessels when your heart contracts or ‘beats’ to pump blood. The second number, called diastolic blood pressure, measures the pressure in your blood vessels when your heart relaxes between beats.

The normal value is 120/80mmHg or less but any BP from 140/90mmHg is too high and if the similar reading is obtained on three separate occasions, it will be deemed as hypertension.

If the systolic blood pressure (SBP) is less than or equal to 120mmHg and the diastolic blood pressure (DBP) is less than or equal to 80mmHg, it is still normal.

SBP greater than 140 and DBP greater than 90 is high.

SBP between 120-139 and DBP from 80-89 is prehypertensive stage; such person is at risk of hypertension.

Does blood pressure has to do with age?

Statistics shows that Systolic blood pressure (SBP) increases with age until the 80 or 90 years while diastolic blood pressure (DBP) rises only until middle age and then either remains steady or slightly decreases.

During those times when doctors had limited understanding about the risks of high blood pressure, people thought the value for pressure should be age plus 100.

How do I know if I have hypertension?

Hypertension or high blood pressure has no symptom and even individual may only be lucky to have symptoms such as headaches or stomach pain. This is why hypertension is often referred to as the ‘silent killer’ in that it may have no warning signs at all.

What will happen to me if I have hypertension?

Something will happen to you if you have HBP that is not controlled. We can sum what will happen to you into long-term and short-term complications. Uncontrolled HBP can will cause artery damage, brain damage, kidney damage, loss of vision, stroke, diabetes among others. It can cause sudden death by causing heart attack.

What is the real cause of hypertension?

Hypertension has no particular cause. Hypertension whose cause or origin is unknown is classed by doctors as primary or essential hypertension. However a pregnant woman with no history of hypertension, who then suddenly has hypertension during pregnancy may be said to have secondary hypertension. Secondary hypertension is the one that commences secondary to a particular condition or disease state. Also there are risk factors that have been known to contribute to or cause hypertension.

What are risk factors or lifestyles that can cause hypertension?

Certain factors some of which are modifiable and some non-modifiable increase the risk of developing hypertension.

Non-modifiable factors

 Age-risk of hypertension increases with age

Sex-overall, men are likely to have HBP than women

Family history

Modifiable factors

Alcohol drinking

Smoking

Excess salt intake

Obesity

Diabetes mellitus

Stress

Is hypertension preventable?

Yes, read the modifiable risk factors and try as much as possible to avoid them. Observe daily yoga. You can fix in physical exercise into your daily time-table.

Is hypertension curable?

There is no cure for hypertension. Cure in this context refers to a drug that will totally eliminate it in such a way that it won’t come back again. Once you become hypertensive, you have to manage it for the rest of your life. An individual may be hypertensive for fifty or more year without any crisis if it is managed and controlled properly over those years

How is hypertension managed?

Once you are diagnosed with hypertension, the first option of management should not be drugs but lifestyle modifications, that is, adjusting the modifiable risk factors such as reducing sodium intake and alcohol as well as creating time for exercise. It is after the HBP is not being controlled by these modifications that we start managing with drugs. Read more here on drug management of HTN.

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Self-monitoring of Blood Pressure SMBP

Individual can take their BP at home or office thanks to availability of automated BP monitors. Patients should be advised not to take their BP several time per week but rather two days per week to avoid paying much attention to their BP. Focusing much on one’s BP can also lead to anxiety that may raise the BP.

Most self monitoring devices are self activated, and misreporting of blood pressure readings is possible. Recently, the use of memory equipped devices has reduced such error, which can also be avoided by adopting telemedicine techniques, which lead to further improvement in controlling blood pressure. Although the technique is easy to learn, some patients may not be good candidates for self monitoring, which may result in anxiety or modification of treatment by the patient.

Step 1: Get a BP monitor

You can purchase a BP monitor from a nearby pharmacy or online pharmacy at an affordable cost. Always bear in mind that a higher price doesn't necessarily correlate to better quality. The digital BP monitor is the one suitable for home use because it requires less effort as the readings are displayed like whole numbers for you, everything is automated. The only thing you will have to learn will be how to fit the cuff round your arm. Your pharmacist or doctor will teach you this.

Step 2: visit a pharmacist or doctor with the BP monitor you purchase

Your healthcare provider will help you to justify your newly purchased device. A pharmacist or doctor will educate you on how to use the BP monitor to read your BP. He/she will probably use manual BP gauge with sphygmomanometer as a control to ensure your BP monitor is taking your correct approximate BP value. You can do that often for a re-evaluation.

Step 3: Take your blood pressure

Before you take your BP, avoid caffeine, alcohol, tobacco, and exercise for at least 30 minutes before measuring your blood pressure.

• Sit with your feet flat on the floor, rest your back against the chair, and place your arm on a table. Your arm and the BP monitor should be on the same level as your heart.
• After sitting quietly for five minutes, wrap the cuff fittingly around the upper part of your bare arm. The center of the cuff should sit over your artery (some blood pressure monitors have an arrow to help you with placement).
• An automatic monitor will inflate by itself when you press a button.
• Check the top and bottom readings on display window. The top number is your systolic pressure—the blood pressure when your heart beats. The bottom number is your diastolic pressure—the pressure in between heartbeats. Write down your blood pressure number each time you measure it so you can track it over time.

Step 4: interpret and utilize your BP reading

Based on the BP monitor reading, you can interpret the results according JNC 7 or 8 guidelines on hypertension.

According to JNC 7, patients with sustained hypertension are further divided into

Stage 1 hypertension (systolic BP 140-159 or diastolic BP 90-99 mmHg)

Stage 2 hypertension (systolic BP ≥160 or diastolic BP ≥100 mmHg) or severe HTN, and those with compelling indications that include diabetes, cardiovascular disease, and renal disease.

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