what is menorrhagia? causes, symptoms, diagnosis and management

Medically Reviewed by Dr Sravya, MBBS, MS

Introduction

Menstrual bleeding that takes more than seven days is known as menorrhagia. Heavy bleeding is another possibility. What symptoms indicate that you are bleeding heavily? Heavy bleeding is defined as the need to replace your tampon or pad in less than two hours or the passage of clots that are at least the size of a quarter. If you suffer this kind of bleeding, you should see a doctor.

You may not be able to live your life to the fullest if heavy or protracted bleeding is left untreated. Anaemia may also result from it. A common blood condition called anaemia can make you feel weak or exhausted. A bleeding issue could result in other medical issues. Sometimes, medical operations like a hysterectomy or a dilation and curettage (D&C) are performed when they could have been avoided.

In This Article

Menorrhagia causes

Possible reasons can be grouped into the following three categories:

1. Issues relating to the uterus

Fibroids or polyps are terms for uterine growths or tumours that are not cancerous.
Uterine or cervical cancer.
Some birth control methods, like an intrauterine device (IUD).
Abnormal bleeding can be brought on by pregnancy-related issues, including a miscarriage or an ectopic pregnancy. A miscarriage occurs when the fetus, or unborn child, passes away inside the uterus. A dangerous condition known as an ectopic pregnancy occurs when a baby begins to develop outside the uterus.

2. Issues relating to hormones

3. Additional conditions or diseases

Additionally, aspirin and other medications can exacerbate bleeding. In half of all the women who have this issue, physicians have not been able to identify the cause. If you experience bleeding like this and your gynecologist did not discover any issues during your usual checkup, you should be evaluated for a bleeding disorder.

What are the symptoms of Menorrhagia?

Menorrhagia symptoms might include various things.
If you can relate to any of the following:

Possess a menstrual flow that requires soaking throughout one or more pads or tampons per hour for several hours.
To control your menstrual flow, you must use two pads.
Need to replace pads or tampons in the middle of the night.
Have periods with blood clots at least the size of a quarter;
Have menstrual cycles that last seven days or more.
Have a strong menstrual flow that prevents you from carrying out your typical activities.
Enduring ongoing lower stomach ache when you are menstruating.
Are you exhausted, lack energy, or have trouble breathing?

Management of Menorrhagia

Diagnosis of Menorrhagia

Because each person may define “heavy bleeding” differently, it can be challenging to determine whether a woman experiences heavy menstrual flow frequently. Menstrual bleeding typically lasts 4 to 5 days and only involves a small (2 to 3 teaspoons) loss of blood. But menorrhagia patients typically bleed for at least seven days and lose double as much blood. You should consult your doctor if your bleeding lasts more than seven days per cycle or is so severe that you need to replace your pad or tampon almost every hour.
Your doctor will inquire about your past medical conditions and menstrual cycles to determine whether you have menorrhagia.

He or she might ask you about things like:

When did you start having periods for the first time?
How long does the average cycle last?
How many days do you typically get a period?
How long has your period been heavy, in your opinion?
How does the quality of your menstruation affect your life?

If any of your family members have experienced severe menstrual bleeding, your doctor might also inquire. To assess whether you require testing for a potential bleeding issue, he or she could also ask you various questions.

You may want to keep track of your periods by noting the dates and the intensity of your flow (perhaps by keeping track of how many tampons and pads you use). Do this ahead of time so you can provide the doctor with as much detail as possible when you visit. In addition to performing a pelvic exam, your doctor may also suggest other tests to assist in determining whether you have menorrhagia.

Tests

Your doctor may recommend one or more of the following examinations to determine whether you have a bleeding issue:

1. A blood test:

Your blood will be drawn using a needle for this test. Then, it will be examined to look for anemia, thyroid issues, or issues with the blood clots.

2. Pap smear:

In this test, cells drawn from your cervix are taken and examined to see whether you have an infection, an inflammation, or cell alterations that could be cancerous or contribute to cancer.

3. Biopsy of the uterus:

To determine if you’re suffering from cancer or other abnormal cells, tissue samples are obtained from the “endometrium” — the inner lining of your uterus. During this test, you could feel as if you are experiencing a severe menstrual cramp. It doesn’t take long, though, and the discomfort normally goes away as the test is over.

4. Ultrasound:

This non-invasive examination uses waves of sound and computer equipment to visualize your organs, tissues, and blood arteries. Then, your doctor may monitor your blood flow and see how they’re performing.

The doctor may suggest additional tests based on the findings of these initial examinations, such as,

5. Sonohysterogram:

After fluid is injected into the uterus through a catheter via your vagina and cervix, an ultrasound scan is performed. This enables your doctor to check for issues with your uterine lining. During this process, you can feel some light to moderate pressure or cramps.

6. Hysteroscopy:

This treatment uses a tiny probe to peer inside the uterus to check for polyps, fibroids, or other issues that could be causing bleeding. There are two types of anesthesia: general anesthesia, which puts you to sleep, and local anesthetic, which numbs the area being examined.

7. Curettage and Dilation (D&C):

This method (or examination) can be used to identify and address the source of bleeding. Your uterus’ inside lining is examined during a D&C to determine the potential source of the bleeding. A D&C is an easy process. Although it is typically performed in an operating room, you won’t need to stay in the medical center afterward. During the process, you can be given medication to put you to sleep or you may get something to numb just the area that has to be operated on.

Treatment of Menorrhagia

The type of medical care you receive will depend on the cause of your bleeding and how severe it is. In addition, your doctor will consider your health in general, your age, medical history, how you respond to particular medications, treatments, or therapies, as well as your needs and wants. For instance, some women simply want to limit the amount of bleeding, while others want to know when they can typically anticipate having their period. Some women hope to continue having children in the future. Others are more concerned with reducing the discomfort than they are with lessening the bleeding. Some medical procedures are continuous, while others are one-time only. To determine which is best for you, you should talk to your doctor about all of your alternatives. A list of the more typical therapies is provided below.

Drug Treatment

1. Supplementing iron:

If you exhibit symptoms of anemia, you should increase the amount of iron in your blood to assist it in carrying oxygen.

2. Advil (ibuprofen):

To lessen discomfort, menstrual cramps, and bleeding. NSAIDS may increase the risk of bleeding in some women.

3. Contraceptive tablets:

To lessen bleeding and help periods become more regular.

4. IUC, or intrauterine contraception:

By the use of devices that release medications into the uterus to assist in reducing bleeding and improving period regularity.

5. Hormone therapy:

Drugs containing estrogen and/or progesterone are used in hormone therapy. To lessen the bleeding.

6. Timate® (desmopressin nasal spray):

By releasing a clotting protein or “factor” that is contained in the blood vessel lining that aids in blood clotting and momentarily raises the quantity of these proteins in the blood, some bleeding diseases, such as von Willebrand disease and moderate hemophilia, can be treated and controlled.

7. Tranexamic acid and aminocaproic acid:

Tranexamic acid and aminocaproic acid are antifibrinolytic drugs. To lessen bleeding by preventing clots from dissolving after they have formed.

Surgical Intervention

1.Curettage and Dilation (D&C):

Curettage and Dilation (D&C) is a technique to lessen menstrual bleeding in which the outermost layer of the uterus lining is removed. It could be necessary to repeat this process in the future.

2. Surgical hysteroscopy:

Surgical treatment can be performed to assist in removing polyps and fibroids, correct uterine abnormalities, and remove the lining of the uterus to regulate heavy monthly flow. It uses a specific tool to inspect the inside of the uterus.

3. Ablation or excision of the endometrium:

Two distinct surgical procedures in which the entire or a portion of the uterine lining is removed to regulate monthly bleeding. Others may still experience periods, but they will be lighter than usual. Some people may completely stop having menstrual cycles. The operations will stop women from conceiving babies in the future even though the uterus is not removed.

4. Hysterectomy:

A serious procedure involving the surgical removal of the whole uterus that requires hospitalisation. A woman who undergoes this surgery will no longer be able to get pregnant, and her period will cease.

Menorrhagia affects many women. However, a lot of women are unaware that they can seek assistance. Others choose not to seek assistance because they feel too ashamed to discuss their situation with a doctor. It’s crucial to communicate honestly with your doctor to get a thorough diagnosis and appropriate course of therapy. In this way, there are several ways for the management of Menorrhagia.

Conclusion

Anyone who has menstrual bleeding that lasts more than seven days or necessitates changing a pad or tampon every hour for many hours straight should consult a physician. The doctor can offer treatment and assist in determining the problem. Inherited bleeding disorders, malignancy, PID, and hormone-related reasons for delayed ovulation can all contribute to heavy menstrual bleeding. Heavy bleeding can occasionally be a side effect of medicine or be the result of difficulties related to pregnancy. Depending on the underlying cause, there are many treatments for abnormally heavy bleeding, including hormonal contraception, hormone therapy, and bleeding-controlling medications. If conventional therapies are unsuccessful, a doctor may occasionally suggest surgery to lessen or halt bleeding.