Menorrhagia

Menorrhagia is one of the commonest gynecologic problems. It is a condition of menstrual periods with abnormally heavy or prolonged bleeding. It disrupts woman’s normal activities and can affect their physical, emotional, and social health.

Approximately, 30-40 ml of blood is lost during a period; in menorrhagia 60-80 ml or more will be lost. It can lead to anemia, fatigue, tiredness, and shortness of breath. Menorrhagia requires medical attention.

The signs and symptoms of menorrhagia include:

  • Constant pelvic or lower abdominal pain
  • Saturation of sanitary pads or tampons every hour
  • Requirement of double sanitary protection
  • Need for change of sanitary protection during the night
  • Bleeding lasting for more than a week
  • Blood clots during menstrual flow for more than one day
  • Symptoms of anemia, such as fatigue or shortness of breath
  • Inability to perform regular activities due to heavy menstrual flow

Menorrhagia can be caused by several underlying conditions. The common causes of menorrhagia include:

  • Hormonal imbalances
  • Intrauterine devices
  • Uterine cancer
  • Dysfunctioning of ovaries
  • Uterine fibroids
  • Uterine polyps
  • Ovarian cancer
  • Miscarriage of pregnancy
  • Ectopic pregnancy
  • Cervical cancer
  • Von Willebrand's disease
  • Platelet function disorder
  • Pelvic inflammatory disease
  • Thyroid disorders
  • Endometriosis
  • Liver or kidney disease
  • Anti-inflammatory and anticoagulants

Menorrhagia is more common in two age groups of women, they are:

  • Girls who have recently started menstruating
  • Older women approaching menopause stage

Menorrhagia can lead to the below medical conditions:

  • Iron deficiency anemia characterized by fatigue and pale skin
  • Severe pain during menstruation

The diagnosis of menorrhagia includes a physical examination along with the following tests.

Blood Tests: A sample of blood will be withdrawn, to evaluate deficiency of iron and other conditions such as blood-clotting abnormalities or thyroid disorders.

Endometrial Biopsy: A sample of tissue from the uterus will be taken to perform laboratory tests.

Pap Test: The cells from the cervix are collected and tested for infection or inflammation. This test also helps to identify the changes that may be cancerous or may lead to cancer.

Ultrasound Scan: High-frequency sound waves are used to produce images of the uterus, ovaries, and pelvis. It helps in identifying abnormalities.

Sonohysterogram: In this test, a fluid is injected through a tube into the uterus through vagina and cervix. An ultrasound will be used by the doctor to look for problems in the lining of the uterus.

Hysteroscopy: It involves insertion of a tiny camera through vagina and cervix into the uterus. It helps to view the inside of the uterus and identify abnormalities.

The treatment for menorrhagia is based on a number of factors such as medical history and overall health, cause, and severity of the condition, future childbearing plans, and effect of the condition on your lifestyle. The drug therapy for menorrhagia includes:

  • Tranexamic acid
  • Iron supplements
  • Oral progesterone
  • Oral contraceptives
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

The hormonal IUD: This is an intrauterine device, it releases a type of progestin called levonorgestrel, which tins the uterine lining and decreases menstrual blood flow and cramping.

If drug therapy is unsuccessful, the doctors may suggest surgery. The treatment options include:

Dilation and Curettage (D&C): In this procedure, the cervix will be dilated, and the tissues of the uterus lining are suctioned or scraped. It reduces menstrual bleeding.

Uterine Artery Embolization: It is used for menorrhagia that is caused by fibroids. In this procedure, the fibroids in the uterus are minimized by blocking the uterine arteries and cutting off their blood supply. During uterine artery embolization, a catheter is passed through the large artery in the thigh and guided into the uterine arteries. Microspheres made of plastic are injected into the arteries.

Focused Ultrasound Ablation: A focused ultrasound ablation is used to treat bleeding caused by fibroids. This procedure uses ultrasound waves to shrink and destroy the fibroid tissue. No incisions are required for this procedure.

Myomectomy: In this procedure, uterine fibroids are removed surgically. This procedure can be done an open abdominal surgery by making several small incisions (laparoscopic), or through the vagina and cervix (hysteroscopic) depending on the size, number, and location of the fibroids.

Endometrial Ablation: The endometrial (uterus) lining is destroyed by this technique.

Endometrial Resection: In this procedure, an electrosurgical wire loop is used to remove the lining of the uterus.

Hysterectomy: It is a surgical procedure performed to remove uterus and cervix. This procedure ends menstrual periods permanently. It is performed under anesthesia and requires hospitalization.