Menorrhagia

Menorrhagia is a condition characterized by abnormally heavy or extended menstrual bleeding. With menorrhagia, you may have an adequate blood loss and pain that disturbs your normal activities.

The most common symptoms of menorrhagia are:

• Menstrual flow that soaks one or more pads per hour for several consecutive hours
• The need to use double sanitary protection to control the flow of blood
• Need to change your pad frequently during the night
• Menstrual period that lasts longer than seven days
• Menstrual flow that includes large blood clots
• Affect the daily routine activities due to heavy menstrual flow
• Fatigue, weakness or shortness of breath (symptoms of anemia)

The cause of menorrhagia is not known in some cases. However, several conditions that  may cause menorrhagia include  hormonal imbalance, dysfunction of the ovaries, uterine fibroids(non-cancerous (benign) tumors of the uterus), uterine polyps, adenomyosis (where endometrial glands are found in the muscular wall of the uterus), intrauterine devices (IUDs), pregnancy complications, cancer, inherited blood disorders, certain medications (anti-inflammatory medications and anti-coagulants), and other medical conditions such as pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease.

Your doctor will do a pelvic examination and may recommend other tests or procedures such as a pelvic ultrasound scan or a biopsy of the lining of the womb if the woman is over 40 years of age. Biopsy is a technique of removing a piece of tissue from the inner lining of the uterus and examining it under a microscope. This is done to make sure that the cells are growing normally. Your doctor may also recommend an examination called hysteroscopy, which involves placing a tiny tube with a light through your cervix to obtain a direct view of the lining of the womb. 

Treatment options will depend on the cause of menorrhagia, the severity of menorrhagia and the overall health of the patient. Some common treatments include:

• Iron supplements may be started if your iron levels are low.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce menstrual blood flow as well as cramping.
• Oral contraceptives may be given to help reduce bleeding and make menstrual cycles more regular.
• Oral progesterone may be given to help correct hormonal imbalance and reduce menorrhagia.
• Mirena is a type of intrauterine device which may be used to release progestin in the womb that thins the uterine lining and reduces the blood flow.
• Tranexamic acid is a nonhormonal method to reduce blood flow.

Surgery may be needed if medication therapy is not successful. The surgical procedures include:

• Endometrial ablation: It is a procedure that permanently destroys the entire lining of your uterus (endometrium) resulting in little or no menstrual flow.
• Dilation and curettage (D&C): It is a procedure in which the cervix is dilated and the lining of the uterus is scraped to reduce menstrual bleeding. You may need additional D&C procedures if menorrhagia recurs.
• Hysterectomy: It is a surgical removal of the uterus and the cervix that leads to infertility and the cessation of menstrual periods.
• Hysteroscopy: This procedure involves the use of a hysteroscope, a tiny tube with a light to view your uterine cavity and to remove abnormalities such as a polyp that may be causing heavy menstrual bleeding.
• Endometrial Resection: It is a surgical procedure that uses an electrosurgical wire loop to remove the lining of the uterus.

Surgical procedures such as hysterectomy, endometrial ablation, and endometrial resection may reduce your ability to become pregnant. Therefore, discuss with your doctor about the treatment options if you plan to get pregnant in the future.