Menorrhagia

What is menorrhagia?

Menorrhagia is abnormally heavy or extended menstrual bleeding.

Symptoms of menorrhagia

• Menstrual flow that soaks one or more pads per hour
• The need to use double sanitary protection to control the flow of blood
• Need to change pads frequently during the night
• Menstrual period that lasts longer than seven days
• Menstrual flow that includes large blood clots
• Daily routine activities are affected by the heavy menstrual flow
• Fatigue, weakness or shortness of breath (symptoms of anemia)

Causes of menorrhagia

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 clotting disorders,
• certain medications (anti-inflammatory medications and anticoagulants), and
• pelvic inflammatory disease (PID),
• thyroid problems,
• endometriosis, and
• liver or kidney disease.
  

In some cases the cause of menorrhagia is not clear despite investigations.

Diagnosis of menorrhagia

We will do a pelvic examination and may recommend other tests or procedures such as

• pelvic ultrasound scan or
• biopsy of the lining of the womb if the woman is over 40 years of age.
• hysteroscopy

With a biopsy of the endometrium a tissue sample is obtained from the inner lining of the uterus and examined under a microscope to rule out malignancy.  A hysteroscopy  involves placing a tiny tube with a light through the cervix to obtain a direct view of the lining of the womb.

Non-surgical treatments for menorrhagia

Treatment options depend on the cause, the severity of menorrhagia and the overall health of the patient.

• 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 an intrauterine device that releases progestrogin into the womb that thins the uterine lining and reduces the blood flow.
   

Surgical treatments for menorrhagia

The surgical procedures include:

• Hysteroscopic resections to remove abnormalities such as polyps or fibroids that may cause menorrhagia.
• Dilation and curettage (D&C): The cervix is dilated and the uterus is scraped to reduce menstrual bleeding. This procedure also allows the gynaecologist to take a biopsy and check for abnormal endometrial cells but is not an effective treatment menorrhagia. It is usually combined with a hysteroscopy.
• Endometrial ablation: Permanently destroys the entire lining of your uterus (endometrium) resulting in little or no menstrual flow. Not suitable for women who want children.
• Hysterectomy: Laparoscopic, abdominal or vaginal. Not suitable for women who want children.