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.
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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:
- Side effects of IUD (intrauterine device)
- Uterine fibroids may result in prolonged or heavier menstrual bleeding.
- Ectopic pregnancy
- Pregnancy complications such as miscarriage, placenta previa or low-lying placenta
- Uterine polyps
- Hormonal imbalance caused due to polycystic ovary syndrome (PCOS)
- Medications, such as anticoagulants
- Menstrual cycles without ovulation (anovulation)
- Inherited bleeding disorders like von Willebrand disease
- Uterine (endometrial) cancer may cause heavy bleeding, especially in postmenopausal women.
- Underlying medical conditions such as cervical cancer, liver disease, kidney disease, thyroid disease, and adenomyosis.
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
Most women suffering from menorrhagia may improve their quality of life by effectively managing the disease. It is important to note that it is not the symptoms of anemia but the reduced quality of life that is driving the patients to seek medical attention. Women with an acute uterine bleeding score below the 25 percentile in quality of life than healthy women of the same age. The clinicians should not only consider the level of morbidity and mortality in such patients but should also consider the effect on the quality of life.
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.
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.
Menorrhagia is one of the most common gynaecological disorder in the world
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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.
- 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.