Menorrhagia is the medical word for menstrual cycles that are unusually heavy or protracted. Although excessive monthly bleeding is a frequent worry, most women do not have significant enough blood loss to be classified as menorrhagia.
Menorrhagia prevents you from doing your normal activities during your period due of excessive blood loss and cramps. Consult your doctor if you dread your period due to severe menstrual flow. There are several successful menorrhagia therapies.
WHAT ARE THE SYMPTOMS OF MENORRHAGIA?
Menorrhagia symptoms and signs may include:
- Using one or more sanitary pads or tampons every hour for several hours in a row
- Using double sanitary pads to control your menstrual flow
- Restricting everyday activities as a result of high menstrual flow
- Having to wake up throughout the night to change sanitary protection
- More than a week of bleeding
- Passing blood clots the size of a quarter
- Anemia symptoms, which includes weariness, exhaustion, and shortness of breath.
WHAT ARE THE CAUSES OF MENORRHAGIA?
The origin of excessive menstrual bleeding is unknown in some situations, however a variety of diseases can result in menorrhagia. Typical reasons include:
- Hormone imbalance: A balance of the hormones estrogen and progesterone governs the growth of the uterine lining (endometrium), which is shed during menstruation, in a regular menstrual cycle. When there is a hormonal imbalance, the endometrium grows in excess and finally sheds through excessive monthly bleeding.
Hormone imbalances can be caused by a variety of illnesses, including polycystic ovarian syndrome (PCOS), obesity, insulin resistance, and thyroid issues.
- Dysfunction of the ovaries: If your ovaries do not release an egg (ovulate) during a menstrual cycle (anovulation), your body does not generate progesterone as it would during a regular menstrual cycle. This causes hormonal imbalance, which can lead to menorrhagia.
- Adenomyosis: This syndrome develops when endometrial glands get buried in the uterine muscle, resulting in severe bleeding and painful periods.
- Intrauterine device (IUD): Menorrhagia is a well-known adverse effect of birth control with a nonhormonal intrauterine device. Your doctor will assist you in developing alternate management strategies.
- Pregnancy complications: A single, heavy, late menstruation might indicate a miscarriage. Another reason of significant bleeding during pregnancy is a placenta in an unusual placement, such as a low-lying placenta or placenta previa.
- Cancer: Excessive menstrual bleeding can be caused by uterine cancer and cervical cancer, especially if you are postmenopausal or have had an abnormal Pap test in the past.
- Uterine fibroids: These benign (noncancerous) uterine tumors form throughout your childbearing years. Uterine fibroids can cause heavy or extended menstrual bleeding.
- Polyps: Uterine polyps are small, benign growths on the uterine lining that can cause excessive or extended menstrual flow.
- Inherited bleeding disorders: Some bleeding diseases, such as von Willebrand's disease, which occurs when a key blood-clotting factor is weak or compromised, can result in irregular menstrual bleeding.
- Medications: Certain medicines, including as anti-inflammatory drugs, hormonal drugs like estrogen and progestins, and anticoagulants like warfarin (Coumadin, Jantoven) or enoxaparin (Lovenox), can all contribute to excessive or prolonged menstrual bleeding.
- Other medical issues: Menorrhagia can be caused by a variety of medical disorders, including liver or renal illness.
WHAT ARE THE RISK FACTORS FOR MENORRHAGEA?
Age and the presence of other medical disorders that may explain your menorrhagia are risk factors. The release of an egg from the ovaries increases the body's synthesis of progesterone, the female hormone largely responsible for regular periods, in a normal cycle. Insufficient progesterone can induce excessive menstrual bleeding when no egg is produced.
Anovulation is the most common cause of menorrhagia in teenage girls. Adolescent females are more vulnerable to anovulatory cycles in the first year following their first menstrual period (menarche).
Menorrhagia in older women of reproductive age is often caused by uterine disease, such as fibroids, polyps, and adenomyosis. Other issues, such as uterine cancer, bleeding disorders, pharmaceutical side effects, and liver or renal illness, might also be causes.
WHAT ARE THE COMPLICATIONS OF MENORRHAGIA?
Excessive or prolonged menstrual bleeding can result in a variety of medical problems, including:
- Anemia: Menorrhagia can result in anemia due to a decrease in the amount of circulating red blood cells. Hemoglobin, a protein that allows red blood cells to transport oxygen to tissues, is used to calculate the quantity of circulating red blood cells.
Iron deficiency anemia occurs when your body tries to compensate for the loss of red blood cells by utilizing iron reserves to produce more hemoglobin, which can then transport oxygen on red blood cells. Menorrhagia has been linked to an increase in the risk of iron deficient anemia.
Pale skin, weakness, and weariness are signs and symptoms. Although food has a role in iron deficiency anemia, heavy menstrual periods worsen the situation.
- Extreme pain: You may experience terrible period cramps in addition to excessive monthly flow (dysmenorrhea). Menorrhagia cramps can sometimes be severe enough to necessitate medical attention.
HOW IS MENORRHAGIA DIAGNOSED?
Your doctor will almost certainly inquire about your medical history as well as your menstrual cycles. You may be requested to keep a diary of bleeding and nonbleeding days, as well as notes on how heavy your flow was and how much sanitary protection you required to regulate it.
Your doctor will do a physical examination and may suggest one or more tests or treatments, such as:
- Blood tests: A blood sample may be tested for iron deficiency (anemia) and other illnesses including thyroid problems or blood-clotting issues.
- Pap test: Cells from your cervix are extracted and analyzed for infection, inflammation, or alterations that might be malignant or lead to cancer in this test.
- Endometrial biopsy: A pathologist may evaluate a sample of tissue from the interior of your uterus taken by your doctor.
- Ultrasound: This imaging technique use sound waves to generate pictures of your uterus, ovaries, and pelvis.
Your doctor may prescribe additional testing based on the findings of your first tests, such as:
- Sonohysterography: During this test, a fluid is delivered into your uterus through a tube via your vagina and cervix. The ultrasound is then used by your doctor to search for issues in the lining of your uterus.
- Hysteroscopy: A narrow, illuminated tool is inserted through your vagina and cervix into your uterus, allowing your doctor to observe the inside of your uterus.
Doctors can be assured of a menorrhagia diagnosis only after ruling out other menstrual diseases, physical ailments, or drugs as probable causes or aggravating factors.
WHAT ARE THE TREATMENTS FOR MENORRHAGEA?
Menorrhagia treatment is based on several criteria, including:
- Your general health and medical background
- The condition's etiology and severity
- Your future plans for childbearing
- The condition's impact on your lifestyle
- Your tolerance to certain drugs, treatments, or therapies
- The possibility that your periods may grow lighter in the near future
- Your thoughts or preferences
Medications
Menorrhagia medical treatment may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs like ibuprofen (Advil, Motrin IB, and others) and naproxen sodium (Aleve) can help reduce menstrual blood loss. NSAIDs also help to alleviate unpleasant menstrual cramps (dysmenorrhea).
- Tranexamic acid: Tranexamic acid (Lysteda) helps minimize menstrual blood loss and should only be used when bleeding occurs.
- Oral contraceptives: Oral contraceptives, in addition to providing birth control, can help regulate menstrual cycles and minimize instances of excessive or extended menstrual flow.
- Oral progesterone: Progesterone, a hormone, can help rectify hormonal imbalances and alleviate menorrhagia.
- Hormonal IUD (Liletta, Mirena): This intrauterine device delivers levonorgestrel, a form of progestin that thins the uterine lining and reduces menstrual blood flow and cramps.
If you experience menorrhagia as a result of hormone therapy, you and your doctor may be able to address the illness by altering or discontinuing the drug.
If you develop anemia as a result of your menorrhagia, your doctor may advise you to take iron supplements on a regular basis. If your iron levels are low but you are not yet anemic, iron supplements may be begun rather than waiting until you become anemic.
Procedures
If medicinal treatment fails, you may require surgical surgery for menorrhagia. Among the treatment possibilities are:
- Dilation and curettage (D&C): To minimize monthly bleeding, your doctor opens (dilates) your cervix and then scrapes or suctions tissue from the lining of your uterus. Although this treatment is frequent and typically successfully resolves acute or active bleeding, if menorrhagia recurs, you may require multiple D&C procedures.
- Uterine artery embolization: The purpose of this surgery for women whose menorrhagia is caused by fibroids is to reduce any fibroids in the uterus by obstructing the uterine arteries and cutting off their blood supply. The surgeon directs a catheter into the big artery in the thigh (femoral artery) and into your uterine arteries, where the blood vessel is filled with materials that reduce blood supply to the fibroid.
- Focused ultrasound surgery: Focused ultrasound surgery, like uterine artery embolization, addresses fibroids-related bleeding by reducing the fibroids. Ultrasound waves are used in this therapy to eliminate the fibroid tissue. This treatment does not necessitate any incisions.
- Myomectomy: Uterine fibroids are surgically removed during this treatment. Depending on the size, quantity, and location of the fibroids, your surgeon may conduct the myomectomy through an open abdominal incision, numerous tiny incisions (laparoscopically), or through the vagina and cervix (hysteroscopically).
- Hysterectomy: A hysterectomy, or removal of the uterus and cervix, is a permanent treatment that results in sterility and the cessation of menstruation. A hysterectomy is a surgical procedure that needs hospitalization. Additional ovarian removal (bilateral oophorectomy) may result in early menopause.
- Endometrial ablation: The lining of your uterus is destroyed (ablated) during this surgery (endometrium). To kill the tissue, a laser, radiofrequency, or heat is delivered to the endometrium.
Most women have much lighter periods after endometrial ablation. Pregnancy following endometrial ablation is fraught with risks. Endometrial ablation patients should utilize reliable or permanent contraception till menopause.
- Endometrial resection: The uterine lining is removed with an electrosurgical wire loop during this surgical technique. Women who have severe menstrual bleeding benefit from both endometrial ablation and endometrial resection. Pregnancy is not advised following this operation.
Many of these surgical treatments are performed as outpatient procedures. Although you may require a general anesthesia, you should be able to go home later that day. A hospital stay is frequently required after an abdominal myomectomy or hysterectomy.
When menorrhagia is caused by another ailment, such as thyroid disease, addressing the underlying cause typically results in lighter periods.