What is menorrhagia?
Menorrhagia is the medical term for unusually heavy or prolonged menstrual periods that disrupts a woman’s normal activities. It is one of the most common gynecologic complaints and about one in every 20 women has menorrhagia.
Normally, the duration of the menstrual cycle is 21-35 days, with bleeding lasting an average of 7 days and blood loss measuring 30-45 milliliters.
Clinically, menorrhagia is defined as total blood loss exceeding 80 milliliters per cycleor menses lasting longer than 7 days. It can also mean passing of blood clots larger in size than a quarter. If untreated, anemia may result. Anemia is a common blood problem that can leave you feeling tired or weak.
What are the signs and symptoms of menorrhagia?
Signs of menorrhagia may include:
- Soaking through 1 or more sanitary pads every hour for many consecutive hours.
- Doubling up on sanitary pads to control menses.
- Changing sanitary pads during the night.
- Bleeding longer than 7 days.
- Blood clots the size of a quarter or larger.
- Bleeding that restricts normal activities.
- Constant pain in lower part of stomach
- Anemia symptoms such as tiredness, fatigue or shortness of breath.
What causes menorrhagia?
During the menstrual cycle, if an egg is not fertilized, the womb lining breaks down, and bleeds. The egg and the womb lining are then shed during menses.
In about half of women with menorrhagia the underlying cause is unknown, but it can be a sign of a serious problem.
When the cause is unknown, it is called dysfunctional uterine bleeding (DUB) or idiopathic menorrhagia. This is the case about half the time. In this condition, the womb and ovaries are normal. It is not a hormonal problem. Ovulation is often normal and the periods are usually regular.
Heavy periods due to dysfunctional uterine bleeding seem to be more common in the first few years after starting periods (menarche), and also in the months running up to the menopause. At these times, periods may be irregular as well as heavy.
- Hormonal imbalance. In a normal menstrual cycle, a balance between the hormones estrogen and progesterone regulates the buildup of the lining of the womb (endometrium), which is shed during menstruation. If a hormone imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding.
A number of conditions can cause hormone imbalances, including polycystic ovarian syndrome (PCOS), obesity, insulin resistance and thyroid problems.
- Growths in the womb: Fibroids are non-cancerous tumors in the muscle of the womb. Polyps are benign growths on the lining of the womb. Both can cause heavy or prolonged menstrual bleeding.
- Dysfunction of the ovaries. If the ovaries do not release an egg during a menstrual cycle (anovulation), the body does not produce the hormone progesterone, as it would during a normal menstrual cycle. This leads to hormone imbalance and may result in menorrhagia.
- Adenomyosis. This condition occurs when glands from the endometrium become embedded in muscle of the womb, often causing heavy bleeding and painful periods.
- Problems related to pregnancy, such as a miscarriage or ectopic pregnancy, can cause abnormal bleeding. A miscarriage is when an unborn baby (also called a fetus) dies in the womb. An ectopic pregnancy is when a baby starts to grow outside the womb, which is not safe.
- Certain types of birth control. Menorrhagia is a well known side effect of using a non-hormonal intrauterine device (IUD) for birth control.
- Cancer. Uterine cancer and cervical cancer can cause excessive menstrual bleeding, especially in postmenopausal women.
- Inherited bleeding disorders. Some bleeding disorders — such as von Willebrand’s disease, a condition in which an important blood-clotting factor is deficient or not functional — can cause abnormal menstrual bleeding.
- Medications. Certain medications, including anti-inflammatory medications, hormonal medications such as estrogen and progestins, and anticoagulants such as warfarin or enoxaparin, can contribute to heavy or prolonged menstrual bleeding.
- Other medical conditions. A number of other medical conditions, including liver or kidney disease, thyroid disease; pelvic inflammatory disease; may be associated with menorrhagia.
Heavy or prolonged menstrual bleeding can lead to other medical conditions, including:
- Anemia. Menorrhagia can cause blood loss anemia by reducing the number of circulating red blood cells. Iron deficiency anemia occurs as the body attempts to make up for the lost red blood cells by using your iron stores to make more hemoglobin, which can then carry oxygen on red blood cells.
Menorrhagia may decrease iron levels enough to increase the risk of iron deficiency anemia. Signs and symptoms include pale skin, weakness and fatigue.
- Dysmenorrhea. Along with heavy menstrual bleeding, there might be painful menstrual cramps (dysmenorrhea). Sometimes the cramps associated with menorrhagia are severe enough to require medical evaluation.
How is menorrhagia diagnosed?
The doctor will take a medical history and ask about the periods of patient. Also, a physical exam including a pelvic exam will be done. Patient may be asked to keep record of her periods and the number of sanitary pads used in few months if she has not done so.
- Blood tests. These check for anemia and test how fast the blood clots.
- Pap test. For this test, cells are collected from the cervix and examined. It’s used to check for malignant (cancerous) changes, infection, or inflammation.
- Ultrasound. Using sound waves and a computer, the doctor can check for fibroids or other problems inside the womb.
- Biopsy. Examining a tissue sample from the womb lining can help the doctor find cancer or other abnormal tissue.
Other tests include:
- Hysteroscopy. Using a viewing instrument inserted through the vagina, to view the cervix and the inside of the womb.
- Dilation and curettage (D&C).This procedure involves scraping and then examining the uterine cavity.
How is menorrhagia treated?
There are various treatment options for menorrhagia. This depends on the cause and severity of bleeding, age, health and the preference of the patient.
- Iron supplement to treat anemia.
- Mefenamic acid and other NSAIDs is used to treat painful menstrual cramps or dysmenorrhea and the amount of bleeding. However, NSAIDs can increase the risk of bleeding.
- Tranexamic acid: an antifibrinolytic agent; reduces the amount of bleeding by stopping a clot from breaking down once it has formed.
- Combined oral contraceptive pill: reduces the amount of bleeding by at least a third in most women. Also helps with dysmenorrhea.
- Oral progesterone: progesterone can help correct hormonal imbalance or reduce heavy menstrual bleeding.
- Desmopressin nasal spray: used in women with bleeding disorders. It boosts the levels of blood-clotting proteins.
- Hormonal Intrauterine device (IUD). To help make periods more regular and reduce the amount of bleeding through drug-releasing devices placed into the womb.
- Dilation and Curettage (D&C). A procedure in which the top layer of the womb lining is removed to reduce menstrual bleeding.
- Operative hysteroscopy. A surgical procedure, using a special tool to view the inside of the womb, that can be used to help remove polyps and fibroids, correct abnormalities of the womb, and remove the lining of the uterus to manage heavy menstrual flow.
- Endometrial ablation or resection. Two types of surgical procedures using different techniques in which all or part of the lining of the womb is removed to control menstrual bleeding. While some patients will stop having menstrual periods altogether, others may continue to have periods but the menstrual flow will be lighter than before. Although the procedures do not remove the womb, they will prevent women from having children in the future.
- Hysterectomy. A major operation requiring hospitalization that involves surgically removing the entire womb. After having this procedure, a woman can no longer become pregnant and will stop having her period.
What is the outlook?
Menorrhagia if left untreated can interfere with daily activities. Also, it can cause anemia, leaving the patient tired and weak. Other health conditions can also result if the bleeding is not resolved. With appropriate treatment and doctor assistance, menorrhagia can be managed and not cause a disruption to patient’s life.
F.O. Adagbonyin, MB.BS in view, certified content creator at Medblog180 and MedicWord, licensed google writer and contributing writer at WikiMedia Foundation.