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\def\RunningAuthor{Harshada B Shirke et al.}
\firstPage{57}
\articleType{Review Article}
\receivedDate{05 Dec 2021}
\acceptedDate{10 Jan 2021}
\revisedDate{08 Jan 2021}
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\title{\textbf{A Review on {\textendash} ``Heavy Menstrual Bleeding and Abdomen Pain During Periods''}}
\author{Harshada~B~Shirke\textsuperscript{*},  
            Vaibhav~V~Kakade, 
            Nikhil~C~Katore~\\[5pt]{Department of Pharmacology, HSBPVT'S GOI, College of Pharmacy, Kashti, Maharashtra, India}}

\begin{abstract}
In medical terms, heavy bleeding is the term called menstrual period with normally or abnormality concerns. Some women do not experience blood loss enough to be defined as \textit{Menorrhagia. In }medical term\textit{s, }Menorrhagia is defined as a common problem that women report to their physician. On average, 10 million American women face this problem every year. It means every single woman out of five women. A 30-year-old mother of two presented to her physician with two years of increased heavy menstrual bleeding (HMB) and server dysmenorrhoea. Heavy menstrual bleeding lasts for more than 7 days. In some cases, there is heavy bleeding. If there is no treatment for this problem, the person cannot live a healthy lifestyle. Due to this problem, there are chances of causing \textit{anemia. } Anemia is a disease in which a person feels tired, weak or have a problem in breathing. Due to the heavy menstrual bleeding, one can't live the normal life social, physical, emotional, well-being and cannot ask for any help from others. Heavy bleeding many causes the disease, which re due to any other disease or problems. You can't do the normal usual activities work or any other job when having heavy menstrual bleeding as compared to the normal bleeding. When the blood flow is heavy, you might suffer from painful cramps and sometimes these cramps, which one related to menorrhagia are serious and they require medical treatment. When periods are heavy, which means the pads which are used get soaked very fastly but using a double pad may give relief and also protect from heavy bleeding. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Menorrhagia,\newline Dysmenorrhoea,\newline Anemia,\newline Heavy menstrual bleeding (HMB)
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Harshada~B~Shirke~\\ Phone:\ 8975532101~\\  Email:\ harshadashirke01@gmail.com
        \par}\vspace*{-11pt}\hrulefill\par{\fontsize{12}{14}\selectfont ISSN: 0975-7538}\par% 
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\section{Introduction}
On average, a girl starts the menstrual cycle at the age of 12. In some cases, girls can begin the menstrual cycle at the age of 8 years age or some late as of 16 years. The menstrual cycle of women stops at the age of 51, and this is referred to as menopause. In this menopause stage, the egg-producing in women is stopped (stop ovulating)\textbf{. } Sometimes health problems cause heavy periods and it may lead to any other health problems. From the very first day of periods, some women have heavy menstrual flow, and the rest of women start heavy periods after a long time or typical periods. 

While women's suffering from heavy periods, they have to face the following Issues: cramps, back pain, Stomach pain, stress, Giddiness etc. 

\textbf{Menstrual Cycle }

The menstrual cycle's length varies from lady to lady; however, the average time of periods is in every 28 days. Normal menstrual cycles occurs from 21 to 40 days. From the first day of periods, menstrual cycles begin. 

Sometimes changes in the periods date occur because of bad lifestyle habits and also due to hormonal changes with respect to age and other factors like stress, various medications and disease condition. \unskip~\citep{1325868:24154411,1325868:24154412}

\textbf{Phases of Menstrual cycle}


  
  \begin{enumerate}
  \item \relax Menstruation 
  \item \relax The follicular phase
  \item \relax Ovulation
  \item \relax The luteal phase \unskip~\citep{1325868:24154449}
  \end{enumerate}
  \textbf{Menstruation }

Menstruation is defined as the removal of blood mucosal tissue via the vagina. Menstrual fluid includes cells from the lining of the uterus and muscle. The period length is between three to seven days.

\textbf{Follicular Phase}

From the first day of periods, the follicular phase starts and ends with ovulation.

\textbf{Ovulation }

Ovulation is defined as the release of a mature egg from the surface of the ovary. This occurs in mid-cycle, around two weeks or before the menstruation cycle starts.

\textbf{Luteal Phase}

The luteal phase is one of the stages of the menstrual cycle. It occurs when the ovaries release the egg and during ovulation, the egg gets bursts from its follicle, but the ruptured follicle stays constant on the surface of the ovary. Further, after two weeks, the follicle gets transformed into a structure which is known as the corpus luteum. 
    
\section{\textbf{Heavy Menstrual Bleeding Causes}}
\textbf{Uterine related problems}


  
  \begin{enumerate}
  \item \relax Due to heavy menstruation, there are problems in the uterine, which is called uterine fibroids.
  \item \relax There are chances of causing cancer of the uterus due to heavy bleeding.
  \end{enumerate}
  \textbf{Hormone-related problems }

In a regular menstrual cycle, stability among the hormones estrogen and progesterone regulates the accumulation of the liner of the uterus (endometrium), that's shed in the course of menstruation. If a hormone imbalance occurs, then the endometrium develops in extra and finally sheds through manner of heavy menstrual bleeding. \unskip~\citep{1325868:24154452}

\textbf{Signs}


  
  \begin{enumerate}
  \item \relax Use of two or more pads in case of heavy bleeding in a day or night.
  \item \relax Use two pads or tampons to avoid heavy blood flow.
  \item \relax During night repeated changing of pads. 
  \item \relax The periods do not stop for more than 7 days.
  \item \relax Increase blood flow than normal.
  \item \relax Having the menstrual flow more due to which it stops a person from living a normal healthy life. 
  \item \relax There is continuous pain in the lower part due to the periods.
  \item \relax The person feels tired, lazy, or weak.
  \end{enumerate}
  \textbf{Diagnosis}

Heavy menstrual bleeding due to primary dysmenorrhoea. The women who have attend the treatment for HMB tell about their physical, social also emotional wellbeing. For every woman, all the history should be studied to know the actual nature of her symptoms. If a woman has high menstrual blood flow even, it is not easy because any person may think of ``heavy bleeding'' in different ways. 

Heavy bleeding lasts for 4 to 5 days and 2-3 tablespoons of blood are lost. Women having menorrhagia may bleed for more than 7 days and they lose blood twice than normal. If a woman has blood flow than the normal or has periods more than 7-8 days or also have to change their pads many times, i.e. every hour, then the woman should consult the doctor. If you consult the doctor, he will ask for the medical history to find out the condition like menorrhagia.
    
\section{\textbf{Treatment}}
The treatment that is to be given will depend on the cause of heavy bleeding and how serious the condition is. The doctor will overlook specific things like health, age, and medical history of a woman. Some common treatments that are given are as follows: 

\textbf{Drug therapy}


  
  \begin{enumerate}
  \item \relax Iron supplement 
  \item \relax Ibuprofen (Advil)
  \item \relax Birth control pills 
  \item \relax Intrauterine contraception (IUC)
  \item \relax Hormone therapy
  \item \relax Antifibrinolytic medicines \unskip~\citep{1325868:24154453}
  \end{enumerate}
  \textbf{Iron therapy}

To increase the amount of iron in blood as it helps to carry out oxygen if it shows signs of anemia. 

\textbf{Ibuprofen (Advil)}

It is used to reduce the pain, cramps during the menstrual cycle, amount of blood flow. The risk of blood flow can increase in some women due to NSAIDS.

\textbf{Birth control pills}

By using pills, it helps women to reduce the bleeding and also regularly to occur of periods.

\textbf{Hormone therapy}

By doing the hormone therapy, the amount of bleeding is reduced. 

\textbf{Desmopressin Nasal spray}

To prevent bleeding in women, having a sure bleeding disorder, like von Willebrand disease and moderate haemophilia, with the aid of releasing a clotting protein or ``factor'', which is stored inside the lining of the blood vessels that allow the blood clots and briefly growing the extent of those proteins inside the blood? 

\textbf{Antifibrinolytic medicines}

To reduce the amount of bleeding by stopping a clot from breaking down once it has formed.
    
\section{\textbf{Tests}}

  
  \begin{enumerate}
  \item \relax Blood test 
  \item \relax Pap test
  \item \relax Endometrial biopsy
  \item \relax Ultrasound
  \end{enumerate}
  \textbf{Blood test}

In this blood test, blood is withdrawn using a needle. Then the blood is taken for testing of anemia or any other problem related to the thyroid.

\textbf{Pap test}

In the Pap test, cells from the cervix are removed and then it is checked to find out any infection, inflammation, or changes that occurred in the cell, which may be serious like cancer or may cause cancer.

\textbf{Endometrial Biopsy}

In this test, a sample of tissue is taken from the inner lining of the uterus or "endometrium" to know the presence of cancer or abnormal cells. During this test, a bad menstrual cramp occurs. But this cramp does not last long, and pain is reduced when the test ends.

\textbf{Ultrasound}

This test is done using sound waves and it is a painless test. A computer is used in this test to show what your blood vessels, organs and tissues are looking like. After this checkup doctor can see how they can work on it and they can check the blood flow.

Using the results of these tests, the doctor might recommend more tests, including:


  
  \begin{enumerate}
  \item \relax Sonohysterogram
  \item \relax Hysteroscopy
  \item \relax Dilation and curettage (D\&C)
  \end{enumerate}
  \textbf{Sonohysterogram}

The ultrasound scanning process is done when the fluid is injected via a tube into the uterus through the vagina and cervix. This can help doctors to see the problems in the lining of the uterus. Short or moderate pressure or cramps are felt during this process.

\textbf{Hysteroscopy}

In this process, the tiny tool is used to look up the inner side of the uterus to see fibroids, polyps and any other problems which may cause bleeding.

\textbf{Dilation and Curettage (D\&C)}

In this process, the cause of bleeding is found out and also treatment for it. During a Dilation \& Curettage test, the inner lining of the uterus is scraped and looked at to see what might be causing the bleeding. D\&C is a simple procedure. Most commonly, it is done in an operating room, but not have to stay in hospital afterwards.
    
\section{Conclusion}
Heavy menstrual bleeding (HMB) is a common symptom that badly affects the healthy lifestyle of women. Heavy menstrual bleeding is defined as the "heavy flow of blood occurring over several consecutive cycles''. On average, 30\% of women's complain about heavy menstrual bleeding (HMB). Health-related symptoms are negatively affected in women who are suffering from HMB. HMB is usually associated with negative perceptions and also having limits in social and professional activities of the day to day life.

\textbf{Conflict of Interest}

The authors declare that they have no conflict of interest.

\textbf{Funding Support}

The authors declare that they have no funding support for this study.
    

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