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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes heavy menstrual bleeding with clots?

i am 45 years old with normal menstrual bleeding earlier but have been having heavy periods with passage of large blood clots since a few it normal just before menopause to have such change in bleeding or is it something to be concerned for....
Mon, 17 Oct 2016
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General & Family Physician 's  Response

Thanks for writing to HCM.

You are right in suspecting that these are the symptoms of start of menopause. Initially there are irregular periods with more or less than normal bleeding, later the periods will become further apart in time and may skip months in between. This will continue till complete stoppage of menses. This period is called premenopause. It typically lasts for 2-10 years.

However, it is important to rule out if there is any pathology of the lining of the uterus as this is also quite a common cause of bleeding at this age. The lining of the endometrium may be abnormally thickened leading to increased bleeding. You may take a small course of Norethisterone 5mg twice a day for 4-5 days (max 10 days) to see if the bleeding decreases. If it does not, and you suffer from symptoms of excessive blood loss like weakness, dizziness and your hemoglobin decreases significantly; you may have to go for a procedure called dilatation and curettage. This is usually an outpatient procedure wherein your uterus lining will be scraped and the tissue samples will be sent for histology to look for any abnormality. Further course of treatment can be decided based on the results.

Hope this helps. Wishing you good health.

Dr Geeta
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