What is Menorrhagia?
- The word is related to late 18th modern Latin, The first part, meno-’of menstruation’ while the second part, rrhag-, stem of Greek rhegnunai ‘to burst’
- It is ‘hypermenorrhea’ which means excessive or prolonged menstrual bleeding in a woman with age between 12-51 years. This age is specific as the woman can get pregnant and bear children. This means from the time they start getting their menstrual period to the time they stop getting it.
Overview
Menorrhagia is a medical term for abnormally heavy prolonged bleeding of the menstrual period. When the woman has a heavy period, she can’t maintain her usual activities because she has so much blood loss and cramping. Menorrhagia is a situation once it happens, you must talk to your doctor and receive an effective treatment.
We will discuss menorrhagia in more detail, and we will answer the following questions about it:
- What are the causes of menorrhagia?
- What is the clinical presentation of menorrhagia?
- How can a doctor diagnose menorrhagia?
- What is the difference between menorrhagia and metrorrhagia?
- What are the risk factors of menorrhagia and how to decrease it?
- What is the treatment of menorrhagia?
Menorrhagia causes
There are many causes of menorrhagia
- Hormone disturbance:
During normal menstrual cycle, the balance between feminine hormones which are called ‘Estrogen’ and ‘Progesterone’ is responsible for regulation of building up the lining of the uterus endometrium which is shed during menstruation. In menorrhagia, hormone imbalance occurs and the result will be excess development of the uterine lining and the thickness of this lining will be exaggerated. At time of menstruation, shedding of the thick endometrium results in heavy menstrual bleeding.
- Ovarian dysfunction:
Ovaries are responsible for what is called ovulation or egg release. If the ovaries don’t perform its normal function, no ovum is produced and the hormone progesterone will not be excreted in the body, as it would during normal menstrual cycle, which in turn results in hormonal imbalance and menorrhagia.
- Uterine fibroids:
They are abnormal growths that develop in or on a woman’s uterus. These tumors are typically benign non-cancerous and the cause is unknown. Uterine fibroids may cause menorrhagia with heavier than normal or prolonged menstrual bleeding.
- Polyps:
They are growths attached to the inner wall of the uterus which extend into the uterine cavity. Polyps result from overgrowth of cells in the lining of the uterus or endometrium, so it is also called ‘endometrial polyps’. Uterine polyps may result in heavy prolonged menstrual bleeding.
- Adenomyosis:
It is a medical term that means the normal tissue which lines the uterus grows into the muscle wall of the uterus. These tissues continue their function by thickening, breaking down and bleeding in every menstrual cycle. Menorrhagia often occurs with heavy bleeding and painful periods.
- Intrauterine device (IUD):
It is a contraceptive device fitted inside the uterus and physically prevents the implantation of fertilized ova to control birth. Menorrhagia is a known side effect of using these devices.
- Pregnancy complications:
Miscariage or abortion is a known cause of menorrhagia. Another cause of heavy bleeding during pregnancy includes low-lying placenta which is an unusual location of the placenta. The placenta partially or wholly blocks the neck of the uterus which induces heavy life-threatening bleeding during pregnancy. On the other hand, the placenta may be normally situated but early separation of the placenta from the uterine wall results in heavy uterine bleeding.
- Cancer:
Uterine cancer and cancer cervix can cause excessive menstrual bleeding. Before menopause, this bleeding is considered menorrhagia but after menopause, the doctors consider it as abnormal uterine bleeding.
- Inherited bleeding disorders:
Some bleeding disorders with absence of one of the clotting factors or impaired can cause abnormal bleeding from different sites and one of these sites is the uterus leading to abnormal heavy menstrual bleeding.
- Medications:
There are some types of medications that can contribute to heavy or prolonged menstrual bleeding. For example, hormonal treatment,anticoagulants and anti-inflammatory medications.
- Other medical disorders:
For example, liver disease or kidney disease may be associated with menorrhagia.
Symptoms of menorrhagia
Signs and symptoms of menorrhagia includes:
- The requirement to use one or more sanitary pads every hour for several consecutive hours.
- Soaking of the pads or tampons even with the use of double sanitary protection.
- Needing to wake up to change the pads during night.
- Bleeding for longer duration more than normal ( the average duration for most of females is about a week)
- Large blood clots pass out with the menstrual blood.
- Heavy menstrual blood flow restricts daily activity.
- Bleeding results in loss of more than 80ml of blood per menstrual cycle.
- Symptoms related to anaemia such as tiredness,easy fatigability and shortness of breath.
Diagnosis of menorrhagia
The doctor will ask about the medical history and the menstrual cycle, so you need to keep a diary of bleeding days including notes on how heavy your flow was. The doctor will examine you and may recommend for more tests such as:
› Blood tests:
A blood sample is examined for anaemia, thyroid disorders or blood clotting disorders.
› Pap test:
This test is specific for early detection of cancer cervix or other changes which may lead to cancer.
› Endometrial biopsy:
Sample of tissues lining the uterus are examined to detect any abnormality.
› Ultrasound:
It is a method of imaging to see the uterus,tubes, ovaries and pelvis using a special machine that depends on sound waves.
› Sonohysterography:
This examination also depends on ultrasound by injecting sterile fluid through a tube into the uterus after passing through vagina and cervix. This test is useful to visualize the lining of the uterus and detects any abnormality
› Hysteroscopy:
This test is used also to examine the lining of the uterus and tubes.
Based on the previous laboratory and imaging tests doctors can be certain of diagnosis of menorrhagia.
Menorrhagia and metrorrhagia
A) Menorrhagia:
As described before is a heavy or excessive menstrual bleeding including prolonged duration of previously usual period or excessive bleeding during normal period duration.
B) Metrorrhagia:
Is also a type of menstrual disorders considered as irregular uterine bleeding not related to the expected time of normal menstrual periods.
C) Menometrorrhagia:
This condition means that there is a combination of both disorders. In other words, it is heavy prolonged uterine bleeding and irregular uterine bleeding at the same time. This condition is more dangerous than if each one of them happens separately.
Premenopausal menorrhagia/ postmenopausal bleeding
A) Premenopausal menorrhagia:
It means heavy menstrual bleeding or prolonged duration of menstruation before menopause. Menopause means the life period between 49-52 years of the women when menstruation ceases.
B) Postmenopausal bleeding:
A post menopausal woman may have a single harmless uterine bleeding after stopping of the menstrual periods for more than a year which is explained by the following causes:
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- Single ovulation: This can happen once so if it occurs you shouldn’t get panic as most probably this will not happen again.
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- Postmenopausal woman which take hormonal therapy: The combination of estrogen and progesterone hormones in the therapy results in bleeding for several months from starting it.
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- Age-related thinning of uterine lining or vaginal tissues due to decreasing of estrogen hormone level.
- Thickened uterine lining: The medical term is ‘endometrial hyperplasia’ which could turn into cancer uterus later on.
Menorrhagia and anaemia
♦ Anaemia as a medical term means that the healthy red blood cells are not enough to be able to carry oxygen to different body tissues.There are different types of anaemia and one of them is iron deficiency anaemia.
♦ Iron deficiency anaemia is a common type of anaemia that is described by insufficient iron. Without enough iron, your body is unable to produce a substance which is important to carry oxygen inside red blood cells called ‘hemoglobin’.
♦ Menorrhagia is accompanied with heavy blood loss which leads to decrease of the number of red blood cells and hemoglobin. The body will try to restore the lost hemoglobin using the iron stores. Menorrhagia may decrease iron levels enough to induce iron deficiency anaemia.
♦ On the other hand, If your body is suffering from iron deficiency anaemia due to any cause such as diet, Menorrhagia can occur as a complication.
♦ In conclusion, Anaemia is the main complication of heavy blood loss followed by symptoms related to anaemia such as tiredness, easy fatigability, weakness, shortness of breath, pale skin and abnormal feeling of cold.
Risk factors of menorrhagia
No clear risk factors of developing menorrhagia. Both young and older women during the reproductive age can complain of excessive menstrual bleeding. However, the causes are not the same. Hormone related causes are often related to younger women and uterine related causes are mostly related to older women.
How to decrease the risk of menorrhagia?
Sometimes we can’t avoid menorrhagia because the risk factor is not well known. Actually, the risk factors may be lowered by:
- Physical fitness and regular exercise.
- Close noticing of the body weight and avoid becoming overweight.
- Treatment of health issues that increase the incidence of menorrhagia.
Treatment of menorrhagia
Treatment of menorrhagia depends on examination and laboratory tests requested by your doctor to discover the cause. At that time the problem could be resolved.When there is no clear underlying cause, treatment will depend on a variety of factors:
- Factors affecting the plan of treatment:
- Your Age.
- Your medical condition and tolerance to specific therapy.
- Your future plan of getting pregnant and having children.
- Your lifestyle and how it will be affected.
- Your opinion.
1) Medications:
There are many drugs could be used for treatment of menorrhagia:
- Oral contraceptive pills:
This can help to control pregnancy, regulate menstrual cycles and reduce excessive menstrual bleeding.
- Oral progesterone:
Progesterone hormone helps in reduction of heavy bleeding.
- Intrauterine device (IUD):
Hormonal type releases progestin which makes the uterine lining thin and decreases the heaviness of bleeding.
- Tranexamic acid:
Helps in reduction of excessive menstrual blood and taken only during menstruation.
- Nonsteroidal anti-inflammatory drugs (NSAIDs):
Help to reduce menstrual blood and at the same time relieve painful cramps.
- Iron supplements:
Used for treatment of iron deficiency anaemia which occurs as a complication of menorrhagia.
2) Surgery:
- Dilatation and curettage(D&C):
The procedure is commonly and effectively performed by your doctor which opens the cervix and removes the tissue lining of your uterus to reduce menstrual bleeding. The results of this procedure are good and successful but may be repeated if this is indicated.
- Uterine artery embolization:
It is a procedure used to treat fibroids without surgery, when the uterine fibroids are the cause of menorrhagia. This procedure is useful to shrink fibroids and by occlusion of uterine arteries and the blood supply of fibroids will decrease and the fibroid will shrink. The surgeon injected special material through the uterine arteries to decrease blood flow.
‘Focused ultrasound surgery’ is a similar procedure to uterine artery embolization as it treats heavy bleeding by using the ultrasound waves to induce destruction of the fibroid tissue. No incisions needed for this procedure.
- Surgical excision of uterine fibroids:
‘Myomectomy’ is the medical term of surgical removal of uterine fibroids.
- Endometrial ablation:
The aim is to destroy the uterine lining (the endometrium).
The doctors use laser beams,radiofrequency or heat to destroy the tissue.
- Resection of endometrium:
Removal of the uterine lining by using a surgical wire loop. Both endometrial ablation and endometrial resection are beneficial for women who suffer so heavy menstrual bleeding.
- Hysterectomy:
It is a surgical operation to remove the uterus and cervix. It is considered definitive treatment of excessive menstrual bleeding. It is performed under general anesthesia. Ovaries if removed in this surgery may lead to early menopause.
In conclusion
Every woman’s condition is unique, this means that what is suitable for you may be not suitable for her. For this reason you should talk with your doctor to search for the best option that is suitable for you and your medical condition. You should discuss with your doctor about the advantages, risk factors, outcomes of each option before taking your decision.
Menorrhagia is a serious problem which has a great impact on your health and lifestyle, so you should understand all the implications on your future health and life especially if the treatment is not only medical but invasive surgical procedure.