What is Menorrhagia?

Heavy menstrual flow is a common disorder in most women. It is medically termed menorrhagia. Heavy menstrual flow can be so much that you just have to change a pad or replace menstrual cup every 2 hours and may last for over 7 days. It can be so bad that sleep is lose. It is usually accompanied with weakness and inability to perform ones daily activity for living.  There is thereore need to contact a medical provider for management options as soon as possible in severe cases.

What are the signs and symptoms ?

Signs of menorrhagia may include some of the followings:

• Having to replace sanitary pads every hour or less for many consecutive hours
• Menstrual periods that last over 7 days
• Menstrual period that keeps you from performing activities of daily living
• Constant lower abdominal pain
• Weakness and shortness of breath
• Doubling sanitary pads in order to prevent menstrual overflow
• Changing pads or tampons during night time
• Passing larger blood clots

Causes

Possible causes fall into the following three areas:

• Growths or tumors in the uterus, that are called uterine fibroids or polyps.
• Cancer of the uterus or cervix
• Intra-uterine devices
• Bleeding-related disorders such as platelet function disorder
• Other medical conditions such as thyroid disease or pelvic inflammatory disease
• Some drugs such as aspirin, can cause increased bleeding
• The menopause transitions
• Hormonal imbalance
• Dysfunction of the ovaries
• Pregnancy complications such as ectopic pregnancy
• Inherited bleeding disorders
• Medications such as anti-coagulants and vasodilators

Diagnosis of Menorrhagia

For menorrhagia to be diagnosed by your doctor, s/he would ask you some questions about your past and present medical history and menstrual cycles, and run some investigations on you.

1. Comprehensive history taking

• Your menarche. That is, the age you started menstruation
• Typical length of your menstrual cycle
• Usual number of days your period lasts
• Number of days your period is heavy
• Quality of life during your period
• History of heavy menstrual bleeding in the family
• Your stress patterns
• Any problem with gain. Such as weight gain or loss
• Current use of any drug

2. Physical examination

• Blood test to rule out anemia and thyroid problems
• Pap test to test for infection, inflammation or cancerous changes
• Endometrial tissue biopsy to examine uterine tissue for any form of pathology
• Pelvic ultrasound to detect any abnormality with the pelvic organs
• Hysteroscopy

Treatment

Specific management of menorrhagia is dependent on several factors which include a comprehensive history taking, assessment and investigations.

Medications

Pharmacotherapy for menorrhagia may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): they help by reducing menstrual blood loss and relieving painful menstrual cramps
• Tranexamic acid.
• Oral contraceptives.
• Oral progesterone: this may be needed to correct hormone imbalance and reduce menorrhagia. However, if menorrhagia is hormone-induced, there is a need to speak with one’s medical provider about changing or stopping it.
• Hormonal IUD. It releases levonorgestrel, which thins the uterine lining and decreases menstrual blood flow and cramping.
• Iron supplement may be prescribed to reduce the chances of anemia

Complications of Menorrhagia

Excessive or prolonged menstrual bleeding can lead to other medical conditions such as

• Anemia: Severe bleeding decreases iron levels. This increases the risk of iron deficiency anemia.
• Severe pain: painful menstrual cramps usually accompany menorrhagia. This may require urgent medical attention

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