Menorrhagia

 

What is menorrhagia?

Menorrhagia (меноррагия, غزارة الطمث) is an abnormal uterine bleeding caused mainly by an alteration in the hypothalamic-pituitary-ovarian axis due to a functional non-organic abnormality (dysfunctional uterine bleeding, it accounts for 75% of all cases). Less commonly, it can be associated with organic causes or pathological disorders, such as organ dysfunction, infections, coagulopathies, or gynecologic neoplasms (it accounts for 25% of all cases). Menorrhagia is characterized by prolonged menstrual bleeding that goes beyond a week (normally, periods last from three to seven days), excessively heavy vaginal bleeding (menorrhagia, or hypermenorrhea), or polymenorrhea (very frequent periods).

Age is the key factor in ruling out Menorrhagia, as gynecologic neoplasms or other organic causes become more frequent with age.

How many days is a normal menstrual cycle?

A cycle is counted from the 1st day of one period to the first day of the next period. On average, a menstrual cycle is 28 days long. However, cycles can range anywhere from 21 to 40 days, especially in young teens.

How do you know if you have a heavy flow?

1. Your periods last more than 7 days
2. If you need to change your tampon or pad after less than two hrs or if you change more than 6-7 tampons or pads a day.
3. You are losing so much blood in each period (a blood loss of 80 ml or more)
4. In case you have hemolytic anemia
5. You get painful menstruation with clots

Symptoms

What are the symptoms of menorrhagia?

Common symptoms of menorrhagia may include:

1. Dysfunctional uterine bleeding, which is characterized by intensity (heavy menses) and duration (prolonged excessive menstrual bleeding)
2. Prolonged menstrual bleeding that goes beyond a week
3. Excessively heavy vaginal bleeding (hypermenorrhea), normally, the amount of blood loss during menstruation is 30 to 35 ml. However, the amount of blood lost during a heavy menstrual period is 60 ml or more
4. Lower abdominal pain that often radiates to the lower back and thighs
5. Bloating, you can feel bloated without actually being distended
6. Very frequent periods (polymenorrhea)
7. Depression
8. Headache
9. Emotional liability
10. Bad appetite

What are the long term complications of menorrhagia?

Without prompt treatment, menorrhagia can lead to other medical conditions, such as:

Hemolytic anemia due to heavy and prolonged menstrual bleeding.

Dysmenorrhea (painful periods, or menstrual cramps) is one of the most common gynecologic disorders that occur just before or during menstruation. It usually lasts less than three days.

Causes

What are the common causes of menorrhagia?

Menorrhagia is mainly caused by an alteration in the hypothalamic-pituitary-ovarian axis (HPG axis), due to a functional non-organic abnormality, especially in women of reproductive age. Abnormal uterine bleeding in postmenopausal women suggests a neoplasm rather than menorrhagia.

Menorrhagia can also be caused by noncancerous (benign) uterine tumors that may cause heavy or prolonged menstrual bleeding, such as uterine fibroids or polyps. Other causes of menorrhagia include thyroid problems (hypothyroidism), pelvic inflammatory disease (PID), endometrial proliferation, endometrial hyperplasia, adenomyosis, polycystic ovary syndrome (PCOS), cervical dysplasia, pituitary disorders, bleeding disorders, an IUD implant, polyps (cervical or endometrial) and ovarian tumors.

Treatment

How to treat menorrhagia?

Classical treatment

Progestin therapy is a first line treatment for menorrhagia, it is commonly used to reduce menstrual bleeding by minimizing the effects of estrogen on target cells. Norethisterone (5 mg three times a day) is a cyclic progestin used to treat menorrhagia.

Oral contraceptive pills (OCPs) are used to reduce blood loss secondary to endometrial atrophy by suppressing pituitary gonadotropin release and preventing ovulation, Natazia (dienogest/estradiol valerate) is an oral contraceptive approved by the FDA for heavy menstrual bleeding. Estradiol valerate/dienogest (E2V/DNG) is a combined oral contraceptive (COC) that contains ethinyl estradiol and a progestin used in the treatment of women with heavy menstrual bleeding. Alternatively, combined oral contraceptive pills (COCP) are often prescribed for the management of menorrhagia and dysfunctional uterine bleeding

Tranexamic acid (TXA) is an antifibrinolytic medication used to treat heavy menstrual bleeding by slowing the breakdown of blood clots

NSAIDs (Nonsteroidal anti-inflammatory drugs), such as ibuprofen (Advil, Motrin), naproxen (Aleve, Anaprox DS) or analgin (Metamizole sodium) are commonly used to alleviate menstrual cramps (dysmenorrhea)

Oral progesterone therapy is used to prevent endometrial hyperplasia and to properly regulate the menstrual cycle. Progesterone plays an important role in the regulation of ovulation and menstruation. Oral micronized progesterone therapy (oral micronized progesterone, OMP) in a dose of 300 mg at bedtime daily for three months or medroxyprogesterone acetate (MPA) in a dose of 10 mg per day for three months can be helpful for heavy menstrual bleeding. Cyclic progesterone therapy (OMP or MPA) must be given with ibuprofen (200-400 mg) when periods are very heavy

Hormonal IUD (Liletta, Mirena, and Skyla IUDs) that work by releasing a low level of the hormone levonorgestrel into the uterus, which is a synthetic derivative of progesterone. Levonorgestrel is a contraceptive commonly used to prevent pregnancy after unprotected sex

• Alternative treatment

Next steps management

How to diagnose menorrhagia?

Your doctor will do a full physical examination and may recommend one or more of the following functional diagnostic tests:

1. A complete blood count (CBC) is a test used to diagnose anemia
2. Hormonal tests (FSH, LH, Estrogen, Progesterone, TSH, T4, Prolactine, Dopamine, parathyroid hormone) to evaluate conditions, such as thyroid or endocrine disorders
3. The Prothrombin time (PT) test is a blood test used to evaluate blood clotting abnormalities and to measure how well and how long it takes your blood to clot. In norm, it takes about 30 seconds.
4. Pap test (pap smear) is a test mainly used to test for the presence of precancerous or cancerous cells on the cervix (to detect signs of cervical cancer)
5. Endometrial biopsy is a common procedure in which a small piece of tissue is removed from the endometrium to screen for abnormal cells in the uterus.
6. X-ray of the skull
7. Pelvic ultrasound
8. Hysteroscopy

Verified by: Dr.Diab (November 21, 2017)

Citation: Dr.Diab. (November 21, 2017). What is Menorrhagia? Causes Symptoms and Treatment. Medcoi Journal of Medicine, 14(2). urn:medcoi:article15584.