Menorrhagia is defined as heavy menstrual bleeding of over 80 milliliters of blood in one cycle or twice the normal amount. The bleeding is so significant that it affects women’s daily activities. The bleeding lasts more than 7 days and it requires the woman to change her tampons and pads every 2 hours or more. The blood loss is also associated with passage of large clots. This loss of blood can lead to anemia along with severe weakness.
How Is Menorrhagia Treated?
Treatment of menorrhagia is given according to the history of the individual keeping in mind the patient’s age, her co-existing medical conditions, family history and most importantly her desire for fertility. Medication cost and adverse effects should also be kept in mind because of patient’s compliance. Your gynecologist will do a physical examination and some tests and procedures as well if they are needed.
A sample of your blood will be taken and tested for iron deficiency anemia and other conditions such as thyroid disorders or bleeding disorders. A pap smear is done in which cervical cells are collected and tested for infection, inflammation or changes that might be suggestive of carcinoma. Endometrial biopsy is done to look for uterine cells abnormality. Ultrasound uses sound waves to produce the images of uterus ovaries and pelvis. Further testing is done based on the results of these procedures.
Sonohysterography is done to look for further problems in the uterus where a fluid is injected into the uterus by way of your vagina and cervix using a tube. After this an ultrasound is done to look for problems in the lining of the uterus. Hysteroscopy involves using a thin lighted instrument to see the inside of the uterus and examine it for any abnormal changes.
Treatment for menorrhagia depends on how serious the bleeding is; the cause of bleeding, your health and medical history. The basic treatment for menorrhagia includes iron supplements to correct anemia, non steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB) or naproxen sodium are to treat menstrual cramps (dysmenorrhea) and reduce amount of bleeding, birth control pills to correct irregular menses and reduce episodes of excessive or prolonged menstrual bleeding, hormonal IUDs (Liletta, Mirena that release a type of progestin called levonorgestrol, which makes the uterine lining thin and decreases menstrual blood flow and cramping), hormone therapy with oral progesterone helps in correcting imbalance and reduce menorrhagia.
Surgery For Menorrhagia
Surgical procedures for menorrhagia include dilatation and curettage (D&C) where the cervix is opened by the doctor followed by scraping and suctioning of the tissue from the lining of the uterus to reduce menstrual bleeding. Uterine artery embolisation is mostly done in people who have fibroids to shrink them and block the uterine arteries by cutting off the blood supply to fibroid. Focused ultrasound surgery is done to shrink the fibroids by destroying them with ultrasound waves. Myomectomy involves removal of uterine fibroids either through the vagina or through small incisions laparoscopically. Endometrial ablation destroys the lining of the uterus using a laser radiofrequency or heat is applied to the endometrium to destroy the tissue. Endometrial resection also involves the removal of lining of uterus. Hysterectomy (removal of uterus) is done where the family is complete to stop periods.
Causes of Menorrhagia
Menorrhagia is mostly caused by hormonal imbalance of progesterone and estrogen. It can occur with or without ovulation. It mostly affects girls who have recently started menstruating or women approaching menopause. When there is a fluctuation in hormone levels the endometrial shedding is increased and heavy menstrual bleeding takes place. Other causes include ovarian dysfunction where the ovary does not release the egg and hence no production of progesterone is there. Uterine fibroids, uterine polyps, adenomyosis, non-hormonal intrauterine device, pelvic inflammatory diseases, pregnancy related complications, cancers of uterus, cervix and ovary, inherited bleeding disorders, and certain medications can all lead to menorrhagia. In some cases thyroid disorders, endometriosis and kidney or liver diseases can trigger menorrhagia.