Menorrhagia (Heavy Menstraul Bleeding)

Menorrhagia is a medical condition in which a woman experiences abnormally heavy or prolonged menstrual bleeding.

In women with menorrhagia, each period is accompanied by enough blood loss and cramping that causes so much pain that makes it difficult for a woman to maintain her day-to-day activities.

There are many effective treatments for menorrhagia.

The signs and symptoms of menorrhagia may be different in different women. Some women experience fewer symptoms and vice versa.

Some of the sign and symptoms include:

• An increased need for sanitary protection due to heavy bleeding.
• Soaking through several (one or more sanitary pads or tampons every hour for consecutive hours).
• Waking up in the middle of the night several times to change the sanitary pad or tampon.
• Bleeding for more than a week.
• The presence of clots in the menstrual flow for more than a day.
• Decreased daily activities due to heavy menstrual bleeding and symptoms of anemia such as tiredness.
• Fatigue.
• Shortness of breath.

Some women with menorrhagia may also experience vaginal bleeding and bleed between periods.

The exact cause of menorrhagia is unknown in some women.

Some of the causes of menorrhagia include the following: Hormone imbalances, disorders in the function of the ovaries, presence of polyps and uterine fibroids and adenomyosis.

Hormonal imbalances occur due to changes in the levels of estrogen and progesterone. These two hormones regulate the menstrual cycle.

Changes in their levels cause the excessive growth of the lining of the uterus and this lining eventually shed of producing heavy menstrual bleeding.

Dysfunction of the ovaries is due to the fact that these disorders are accompanied by hormonal imbalances.

Uterine fibroids and polyps are benign (non-cancerous) tumors. These tumors occur mostly in women in their childbearing years.

They prolong the duration of bleeding since they affect the levels of estrogen and progesterone.

Complications during pregnancy and Intrauterine devices (IUD) which are used as a form of contraceptives can also cause menorrhagia.

Other causes include cancer, hereditary bleeding disorders like von Willebrand's disease and medications that increase the duration and frequency of bleeding.

In order for the diagnosis of menorrhagia to be made, it is important that the history of the patient is taken especially the history of menstrual cycles.

A physical examination and lab investigations can also be performed.

The lab tests include:

Blood tests - in which a sample of blood is taken to evaluate the levels of hormones and iron deficiency anemia.

Pap test- in this test, cells are taken from the cervix and are evaluated to check for infection, inflammation or signs of cancer.

Endometrial biopsy- tissue samples are taken from the uterus and are examined under the microscope to check for abnormalities in the cells.

An ultrasound scan can also be used to produce images that help to view the condition of the uterus, ovaries, and pelvis.

Further tests to prove the diagnosis of menorrhagia include:

Sonohysterogram, in this test, fluid is injected into the uterus through the vagina and cervix, this enables doctors to check for abnormalities in the structure of the lining of the uterus and hysteroscopy in which a small camera is inserted into the uterus to allow doctors to view the uterus lining. This camera is inserted through the vagina.

Several treatments are available for women with menorrhagia. These include drug therapies and surgery.

Drug therapies that are used include iron supplements for patients who develop anemia as a consequence of heavy menstrual bleeding, Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin B) and naproxen (Aleve) which reduce bleeding and reduce the pain associated with menorrhagia and oral progesterone.

Taking oral contraceptives and using hormonal IUD like Mirena has also been shown to be effective in the treatment of menorrhagia.

Surgery is usually performed when drug therapy proves to be ineffective.

The following surgical procedures are used:  

• Dilation and Curettage (D&C) in which the lining of the uterus is scraped and removed through a suction system.
• Uterine artery embolization in which blood supplying the uterus is blocked.  
• Focused ultrasound ablation -in this procedure waves are used to shrink destroy or fibroids that cause heavy bleeding.
• Incisions are not required in this procedure.

Other procedures include:

• Myomectomy - surgical removal of fibroids.
• Endometrial ablation - a destruction of the uterine lining.
• Hysterectomy- permanent removal of the uterus and cervix that causes sterility and ends menstrual periods.

Treating the underlying disease in cases where menorrhagia is caused by another disease like thyroid disease can lessen the heavy bleeding seen in menorrhagia.

There are several risks and complications associated with menorrhagia (heavy menstraul bleeding).

Because menorrhagia is mostly caused by hormonal imbalances, any condition that causes a disturbance in the levels of estrogen and progesterone could potentially cause menorrhagia.

Changes in the levels of these hormones usually occur when there are menstrual cycles without ovulation .i.e. the release of an egg from the ovaries.

This is accompanied by a decrease in the level of progesterone which will eventually cause heavy bleeding.

This is typically seen in young girls who have recently started menstruating and in older women who are approaching menopause.

The most common complications of menorrhagia are a severe pain due to cramping and iron deficiency anemia which is a direct result of excessive menstrual bleeding.