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Menorrhagia is the name given to heavy and prolonged menstrual periods, is that disrupt a woman's normal activities.
It is one of the most common gynecologic complaints, and it affects over 10 million women in the United States annually.
Contents of this article:
What is menorrhagia and what causes it?
Signs and symptoms
Treatment
Diagnosis
What is menorrhagia and what causes it?
Average blood loss during menstruation is around 30 to 40 milliliters, or 2 to 3 tablespoons, over a period of 4 to 5
days. Officially, menorrhagia is a loss of over 80 milliliters of blood in one cycle, or twice the normal amount.
An alternative definition that has been suggested is, "Menstrual loss that is greater than the woman feels she can
reasonably manage."
This type of flow lasts longer than 7 days, and it requires a woman to change her pad or tampon every 2 hours or more.
She may also pass blood clots larger in size than a quarter, and she may experience anemia due to the volume of blood
loss.
Menorrhagia is one of the most commonly reported gynecologic complaints. In half of the women diagnosed, an
underlying cause cannot be identified, but it can be a sign of a serious problem.
Causes
Menorrhagia may happen when a menstrual cycle does not produce an egg, leading to a hormone imbalance. Menstrual
cycles without ovulation, known as anovulation, are most common in those who:
Have recently started menstruating
Are approaching menopause
Other underlying reasons for menorrhagia may be:
Hormonal disturbances just before the menopause can lead to heavy bleeding.
Hormonal disturbances: If there is a change in the normal fluctuations of progesterone and estrogen, the
endometrium, or inner lining of the uterus, can build up too much. This is then shed during menstrual bleeding.
Ovarian dysfunction: If the ovary does not release an egg, no progesterone is produced, resulting in a hormone
imbalance.
Uterine fibroids: These are noncancerous, or benign, tumors.
Uterine polyps: These benign growths can result in higher hormone levels.
Adenomyosis: Glands from the endometrium become embedded in the muscle of the uterus.
Non-hormonal Intrauterine Device (IUD): This type of birth control device can lead to heavier bleeding than
normal.
Pelvic inflammatory disease (PID): This is an infection of the reproductive organs that can have severe
complications.
Pregnancy-related complications: Examples are a miscarriage or an ectopic pregnancy.
Cancer: Uterine, cervical, and ovarian cancers affect the reproductive system.
Inherited bleeding disorders: These include Von Willebrand's disease or a platelet function disorder.
Heavy vaginal bleeding, resulting in the saturation of one or more sanitary pads or tampons every hour for several
hours
Heavy bleeding requiring the use of double sanitary protection
Having to change pads or tampons in the middle of the night
Tranexamic acid, or Lysteda, taken at the time of bleeding to help reduce blood loss
Oral contraceptives to regulate the menstrual cycle and decrease bleeding duration and quantity
In women who have a bleeding disorder, such as von Willebrand's disease or mild hemophilia, Desmopressin nasal spray,
or Stimate can boost the levels of blood-clotting proteins.
Nonsteroidal anti-inflammatories (NSAIDs), such as ibuprofen, or Advil, can be used to treat dysmenorrhea, or painful
menstrual cramps, and they can help reduce blood loss. However, NSAIDS can also increase the risk of bleeding.
Surgical interventions
A number of surgical procedures are available to treat or relieve the symptoms of menorrhagia.
Dilation and curettage (D&C) is a surgical procedure for scraping the lining of the uterus
Uterine artery embolization treats fibroids, a cause of menorrhagia, by blocking the arteries that feed them
Hysteroscopy involves inserting a camera into the uterus to evaluate the lining, assisting in the removal of fibroids,
polyps, and the uterine lining.
Focused ultrasound ablation uses ultrasonic waves to kill fibroid tissue.
Myomectomy is a surgical intervention to remove uterine fibroids through several small abdominal incisions, an
open abdominal incision, or through the vagina.
Endometrial ablation permanently destroys the lining of the uterus.
Endometrial resection uses an electrosurgical wire loop to remove the uterine lining.
Hysterectomy removes the uterus and cervix, and, sometimes, the ovaries.
The choice of intervention will take into account the cause and extent of the condition, the age and health of the patient,
and their personal preference and expectations.
Diagnosis
A doctor will ask the patient about symptoms and will carry out a physical examination.
Blood tests to check for disorders such as anemia, thyroid disease, and clotting disorders
Pap smear to evaluate for cervical infection, inflammation, dysplasia, and cancer
Endometrial biopsy to test the lining of the uterus for cellular abnormalities and cancer
Ultrasound to evaluate the pelvic organs including the uterus, ovaries, and pelvis
Sonohysterogram, which involves instilling fluid into the uterus and using ultrasound to evaluate the uterus for
abnormalities
Hysteroscopy, in which a camera is inserted into the uterus to inspect the lining
Dilation and curettage, used as treatment but also to detect abnormalities
Keeping a diary of the length and heaviness of menstruation may help in diagnosis.
Metrorrhagia: Irregular bleeding that happens between cycles and does not appear to be linked to menstruation
Postmenopausal bleeding: Occurs more than a year after the last normal period at the menopause
University of the Cordilleras
College of nursing