Menorrhagia

What is Menorrhagia?

The menstruation period with abnormally heavy or prolonged bleeding is called menorrhagia. It lasts for more than seven days. Menorrhagia affects normal life activities and can lead to a deficiency of blood called anemia. The average blood loss is around 30 to 40 ml during menstruation over a period of 4 to 5 days. However, there is twice the normal blood loss in one cycle of menorrhagia. It is about 80 ml of blood loss in a single cycle. Heavy menstrual bleeding can be a temporary or lifelong condition. It is essential to consult the gynaecologist so the cause of the menorrhagia can be found and treated on time.

Medica’s Obstetrics and Gynaecology department endeavours to bring the highest quality of treatment and service to you. We believe in administering holistic management of all patients, encompassing their mental, physical and emotional health as a means to provide a complete solution for all their gynaecological problems. Our department is fully integrated with state-of-the-art treatment units and facilities that enable our Gynaecologists to treat you better.

Symptoms of Menorrhagia

The signs and symptoms of menorrhagia are:

• Needing to use two sanitary pads to control blood flow
• Having to change the pad or tampon after every 2 hours.
• Bleeding longer than seven days
• Seeing blood clots larger than a quarter in the blood
• Restricting daily activities due to heavy bleeding
• Need to change the pads or tampons in the middle of the night
• Symptoms of anemia
• Constant abdominal and pelvic pain
• Heavy menstrual cramps

Causes of Menorrhagia

There are many potential causes for menorrhagia. It can be due to an imbalance in hormones and a structural issue with the uterus. During each cycle, if a sperm does not fertilize an egg, the uterine wall breaks down and leads to bleeding. The unfertilized egg and uterine line are shed during the period. Some of the causes of menorrhagia are:

Other Risk Factors of Menorrhagia

The various risk factors which increase the chances of menorrhagia are:

• Fibroids and polyps
• Dysfunction of ovaries
• Hormonal imbalance
• Intrauterine devices (IUDs), may lead to excessive bleeding
• Pelvic inflammatory diseases
• Complications in pregnancy
• Uterine, ovarian, or cervical cancer
• Rare conditions such as adenomyosis (in which endometrial tissue grows and results in bleeding)
• Inherited bleeding disorders such as Willebrand’s disease (a condition in which blood clotting factor is deficient or impaired)
• Medications, especially anti-inflammatory medications and hormonal medications

Prognosis of Menorrhagia

When to Consult a Doctor?

You should consult the doctor when you experience heavy and painful menstruation bleeding. You should also consult a gynaecologist for any vaginal bleeding after menopause. If bleeding lasts for more than seven days, kindly visit the doctor as it may lead to blood deficiency. It is appropriate to seek help as soon as possible. As bleeding affects your daily activities, It also starts affecting your social, emotional, and physical wellbeing.

Diagnosis

The different types of tests performed to determine the cause of menorrhagia are:

• Blood tests: The doctor performs tests to gather information about hormonal levels, iron deficiency, or thyroid function. These are also used to find the underlying cause of menorrhagia.
• Ultrasound: Ultrasound of the uterus is done to check for fibroids, polyps, and abnormal masses of tissue (cancer).
• Pap test: This test is done to check for cervical changes, cancer, inflammation, or infection of uterine
• Hysteroscopy: This minimally invasive procedure helps to analyze uterine lining and cavities.
• Biopsy: Endometrial biopsy is carried out to check for abnormal tissue or cancer in the uterine lining.
• Sonohysterogram: Fluid is injected through a tube into the uterus through the vagina and cervix. Then ultrasound is performed to look for problems in the uterus lining.

Treatment

Several treatment options are available for managing menorrhagia. The type of treatment depends on the cause of menorrhagia.

Hormonal Imbalance Treatment:

• Prostaglandin Inhibitors: It includes NSAIDs (Non-steroidal anti-inflammatory medicines) such as ibuprofen and aspirin, which reduces the amount of blood and cramping.
• Birth Control Pills: These pills stop releasing an egg. It results in less bleeding during menstruation.
• Oral progesterone is given to regulate hormonal balance.
• Intrauterine Devices: They release progestin which makes the thin uterine lining. It reduces blood flow and cramping.
• Tranexamic Acid Medications: They promote blood clotting, which helps to slow the blood flow.
• GnRH Agonists: These are the types of medicines that temporarily reduce menstrual bleeding. It is usually recommended for patients looking for surgical treatment.

Iron Supplements: The doctor will suggest iron supplements if you have anemia due to heavy blood loss.

Surgical Options:

• Dilation and curettage (D&C): In this procedure, the surgeon removes the top layer of the uterus lining. It reduces the blood flow during menstruation.
• Hysteroscopy: In this, the surgeon cuts the abdomen and uses a tool to view the inside of the uterus. It is done to remove fibroids, polyps, and abnormalities of the uterus to manage blood flow.
• Endometrial ablation: It is a treatment that removes or destroys most of the lining of the uterus. It helps in reducing heavy menstrual bleeding.
• Hysterectomy: This surgical process involves the removal of the entire uterus. Women no longer get pregnant after a hysterectomy.
• Myomectomy: It is performed as an alternative to hysterectomy. This procedure is used to remove fibroids (most common female uterine cancer). This procedure preserves the uterus and childbearing capacity of women.
• Endometrial resection: In this surgical technique, a part of the uterus lining is removed to control menstrual bleeding.