One of commonest reasons why Jamaican women go to see the gynaecologist for treatment are blood clots and excessive bleeding, notes Kingston-based gynaecologist, Dr Fantosh Kulkarni.

As science improves on its way of treating the problem, there is the possibility of successful treatment for almost everyone affected, he also states.

Clots during menstruation actually means excess sino-bleeding or excess flow. Menstrual blood, unlike normal blood (which has coagulation factors to prevent haemorrhage) does not clot. It remains liquid so it can flow out of the body.

However, when there is excessive bleeding, the body's ability to keep menstrual blood liquid is overwhelmed and the extra amount of blood presents as clots. The average menstrual blood loss is 40 ml for each period. Double this figure is considered the highest point of normal. Greater than 80 ml is considered considered loss. A woman experiencing excessive blood loss will have clots.

According to Dr Kulkarni, it is not the clot which worries doctors, but what it represents as a sign of excessive blood loss. Cases will, therefore, be examined in detail to evaluate some of the causes.

hormone imbalance

The gynaecologist notes that - depending on age group - the causes of excessive blood loss vary. In adolescence, the most common cause of excess bleeding is a hormone imbalance. In slightly older women, the cause is often due to uterine fibroids. Other causes include use of the copper-based IUD contraceptive.

Later on in life, another cause is endometriosis. In the elderly, excessive blood loss may be related to bone cancer.

The family doctor or specialist will carefully question the woman and order the appropriate tests to locate cause.

One of the complications of excess blood loss is anaemia, tiredness, swollen feet and a feeling of persistent exhaustion. While the medical doctor searches for cause and decides on treatment, he or she will recommend the use of iron tablets.

Where there is a growth, or a fibroid is suspected, an ultrasound will be done.

The problem may be linked to ovaries. In rare cases it may be a genetic problem of deficiency in the chemicals responsible for clotting. It could also be a thyroid gland or adrenal gland problem. A blood test will be done to indicate cause.

uterine polyps

A Pap smear will also be done to check for cancer of the womb. The specialist may also do a D and C to remove tissue for analysis to determine the effect on the lining of the womb. If the loss of blood is due to uterine polyps or overgrowth, the D and C will provide both diagnosis and treatment.

Further medication will be given appropriately - including hormone drugs, injections or the contraceptive pill to reduce bleeding.

Surgical operations are not recommended for adolescents, who may grow out of the menstrual problem as they get older. If the cause is the IUD coil, it will be changed. If the woman is older and closer to menopause - late 40s and 50s - or if she is diagnosed for cancer - the recommendation for treatment will include a hysterectomy.

Newer treatments include laser treatment which destroys the lining of the womb. There is also electricity or freezing methods, or hot water balloon treatments.

New, also, is Uterine Artery Embolisation for small to medium fibroids. In this procedure, an X-ray specialist sends a long plastic-like tube through the arteries and veins of the groin, all the way to uterus and inject particles which block off the main artery and constrict circulation to womb. Both the womb and fibroids will shrink.

According to Dr Kulkarni, at least 50 per cent of women gain benefit temporarily from these newer treatments. For those in which they fail, surgery will be recommended.

- Outlook Team