What Is Menorrhagia?

Menorrhagia is the medical term used to describe menstrual periods with abnormally heavy or prolonged bleeding. Although many women get heavy periods, most women do not experience blood loss severe enough to be defined as menorrhagia.

Menorrhagia can have a major impact on a woman’s usual activities during her period. Severe blood loss and cramping prevents her from being able to complete routine activities, especially in a social setting. Women who dread getting their periods due to the anticipated excessive blood loss and pain, should seek medical advice from their doctor. If Menorrhagia is diagnosed, many effective treatments are available.

 

What Are The Symptoms of Menorrhagia?

Many women experience unpleasantly heavy or painful periods which can still be considered ‘normal’. Women with menorrhagia, however, usually experience more severe signs and symptoms, including:

• Soaking through one or more sanitary pads or tampons every hour for more than 2 hours.
• Needing to use double pads or tampons to control their menstrual flow
• Needing to wake up to change their pad or tampon during the night
• Bleeding for longer than a week
• Passing blood clots larger than 1 inch.
• Restricting their daily activities because of heavy menstrual flow
• Symptoms of anaemia, such as tiredness, fatigue, or shortness of breath

 

What Causes Menorrhagia?

Doctors are often unable to find the exact cause of menorrhagia in their patients. In such cases it might be necessary to see a specialist gynaecologist and have further tests done. There are, however, many factors that are known to cause this bleeding disorder, namely:

• Uterine growths or tumours such as fibroids or polyps
• Cancer of the cervix or uterus
• Certain types of non-hormonal intrauterine devices (IUD), such as the copper IUD.
• Problems relating to pregnancy, such as a miscarriage or ectopic pregnancy
• Hormone-related problems - when a hormone imbalance occurs, the endometrium (lining of the uterus) becomes very thick and eventually sheds by way of heavy menstrual bleeding. This imbalance may be caused by conditions such as polycystic ovary syndrome (PCOS), obesity, insulin resistance and thyroid problems.
• Bleeding-related disorders, such as von Willebrand disease (VWD) or platelet function disorder.
• Other health conditions such as such as liver-, kidney-, or thyroid disease, pelvic inflammatory disease and cancer.
• Certain medications – blood thinning medication, such as aspirin, can cause increased bleeding.

 

How Is Menorrhagia Diagnosed?

Menorrhagia is usually diagnosed by the symptom of excessive menstrual bleeding. A normal period lasts about 4 to 5 days and the amount of blood lost is around 2 to 3 tablespoons. However, women with menorrhagia usually bleed for more than 7 days and lose twice as much blood.

If you think that you might have menorrhagia, it is useful to track your periods by writing down the dates of your periods and how heavy your flow is (e.g. by counting how many pads or tampons you use). This information is very helpful for when you see your doctor.

Based on your symptoms and medical background, your doctor may want to do further tests to gather more information about your bleeding problem. These tests can include:

• Blood tests - to check for anaemia, thyroid problems, or blood clotting issues.
• Pap test - to check for infection, inflammation, or precancerous changes to your cervix.
• Endometrial biopsy - tissue samples are taken from your endometrium (inside lining of your uterus) to determine if you have cancer or other abnormal cells.
• Ultrasound – to check that your pelvic organs and blood vessels are functioning properly.
• Sonohysterogram - an ultrasound scan is done after filling your uterus with a special fluid. This allows your doctor to view problems in the lining of your uterus.
• Dilation and Curettage (D&C). This is a procedure can be used to find and treat the cause of bleeding. During a D&C, the inside lining of your uterus is scraped and looked at to see what might be causing the bleeding.
• Hysteroscopy – this procedure that allows your doctor to look inside your uterus in order to diagnose and treat the causes of abnormal bleeding, such as fibroids or polyps. A hysteroscope is a narrow tube or telescope with a light and camera at the end that enables your doctor to clearly see your cervix and uterus.

 

How Is Menorrhagia Treated?

The type of treatment you receive will depend on the cause of your excessive bleeding and how serious it is. Your doctor will also consider your general health, medical history and your wants and needs. More conservative solutions might lessen the bleeding while certain surgical treatments can stop the bleeding completely. You should discuss all available options with your doctor to decide on what is right for you. Treatments may include:

Medication

Medication to ease the symptoms of menorrhagia may include iron supplements for anaemia or ibuprofen to reduce menstrual cramps. Hormonal contraceptives, such as birth control pills, hormonal IUDs (Mirena) or hormone therapies can reduce the amount of bleeding. Antifibrinolytic medicines can also reduce the amount of bleeding by stopping a clot from breaking down once it has formed.

 

Surgical Treatment

A dilation and curettage (D&C), in which the top layer of the uterus lining is removed, may be done to reduce menstrual bleeding. This procedure will usually have to be repeated over time. Another commonly performed procedure is an operative hysteroscopy which can remove polyps and fibroids, correct abnormalities of the uterus, and remove the endometrium to manage heavy menstrual flow.

 

Endometrial Ablation

Endometrial ablation and endometrial resection are relatively minor surgeries that can be performed to remove all or part of the endometrium. This procedure can lighten or completely stop menstrual flow. Women will not be able to have children after this procedure.

 

Hysterectomy

A hysterectomy is a major operation to remove a woman’s uterus. Once the uterus is removed, a woman will no longer have periods (menstruate). As a result, all the symptoms associated with menorrhagia will cease immediately.