How to manage continuous menstruation for a month?

Management of Continuous Menstruation for One Month

For continuous menstruation lasting one month, first rule out underlying gynecological problems, then consider a 3-4 day hormone-free interval if using hormonal contraception, or initiate NSAIDs such as ibuprofen 600-800mg every 6-8 hours for symptom management. 1, 2

Evaluation for Underlying Causes

Before treating prolonged menstruation, it's essential to determine if there's an underlying cause:

• Potential causes to consider:

  • Inconsistent use of hormonal contraceptives
  • Medication interactions
  • Cigarette smoking
  • Sexually transmitted infections
  • Pregnancy
  • Structural abnormalities (polyps, fibroids)
  • Endometriosis or adenomyosis

• Warning signs requiring immediate evaluation:

  • Severe pain unresponsive to medication
  • Very heavy bleeding (soaking through pad/tampon hourly)
  • Dizziness or lightheadedness suggesting anemia

Management Approach Based on Contraceptive Use

For Women Using Extended or Continuous Hormonal Contraceptives:

1. If using combined hormonal contraceptives continuously:

   • Advise a 3-4 day hormone-free interval to allow for withdrawal bleeding
   • Important: Do not take a hormone-free interval during the first 21 days of starting the method
   • Do not take more than one hormone-free interval per month as this may reduce contraceptive effectiveness 1

2. If bleeding persists after hormone-free interval:

   • Consider alternative contraceptive methods
   • Evaluate for underlying gynecological problems

For Women Not Using Hormonal Contraceptives:

1. First-line treatment:

   • NSAIDs such as ibuprofen 600-800mg every 6-8 hours with food for the first 24-48 hours
   • This helps reduce menstrual flow and cramping by inhibiting prostaglandin synthesis 3, 2

2. Additional supportive measures:

   • Applying heat to lower abdomen or back
   • Ensuring adequate iron intake to prevent anemia
   • Maintaining hydration

When to Consider Hormonal Management

If prolonged bleeding continues despite initial management:

• Combined hormonal contraceptives can be effective for regulating menstrual cycles 3, 4
• Levonorgestrel-releasing IUD is an excellent option for women with abnormal uterine bleeding and can reduce menstrual flow by up to 90% 3
• Tranexamic acid may be considered as an alternative non-hormonal option 3

Common Pitfalls to Avoid

1. Dismissing prolonged bleeding as normal variation

   • Menstrual cycles longer than 90 days are considered abnormal, even in adolescents 5
   • Prolonged bleeding can indicate underlying health issues and should be evaluated

2. Overlooking impact on quality of life

   • Prolonged menstruation can significantly affect daily activities and overall wellbeing 4
   • Addressing both physical symptoms and emotional impact is important

3. Failing to provide anticipatory guidance

   • When starting hormonal contraceptives, counsel patients about potential changes in bleeding patterns, especially during the first 3-6 months 1
   • Unscheduled spotting or bleeding is common initially and generally decreases with continued use

Remember that menstrual disorders affect approximately 2.5 million women annually and can significantly impact quality of life 4. Early identification and management of abnormal menstrual patterns can prevent complications and improve overall health outcomes.