What Are Menorrhagia And Metrorrhagia?

Metrorrhagia is abnormal bleeding that occurs between periods or bleeding that is not associated with menstruation. It may be a sign of an underlying disorder such as hormone imbalance, endometriosis, uterine fibroids or carcinoma of uterus. Whereas menorrhagia is heavy menstrual bleeding that is more than the usual or twice the normal amount of blood loss. Menorrhagia flow can last for more than 7 days that requires the woman to change her tampon or pad every 2 hours or more.

The normal menstrual cycle is a regular process that is regulated by hormones and lasts around 28 days. Under the influence of hormones progesterone and estrogen each month the uterine lining thickens and builds up extra blood and tissue preparing it for implantation. If the egg is not fertilized, then it does not implant and is passed through the reproductive system prostaglandins causes the uterus to contract. The uterine line is shed and the blood flows out through the vagina. Any imbalance in the hormones or presence of abnormalities in the uterus will lead to menorrhagia and metrorrhagia.

There can be many causes of metrorrhagia that include hormone imbalances caused by birth control pills problems in production of hormones by the hypothalamus and other glands. Presence of fibroids, polyps, scar tissue, inflammation and tumor in the uterus and cervix might lead to metrorrhagia. The other causes include vaginal infections, genital warts or yeast infection. An IUD used for birth control, chronic conditions like diabetes and thyroid disorders can contribute to metrorrhagia. Some blood thinning medications may also cause bleeding.

The main symptom of metrorrhagia is light to heavy bleeding between menstrual periods. Cramps may or may not be present with bleeding. When there is a miscarriage and ectopic pregnancy severe cramps with bleeding may be present.

Menorrhagia may be caused by hormonal disturbances caused by fluctuations in the level of progesterone and estrogen, ovarian dysfunction where during a menstrual cycle an ovary is not released and no production of progesterone takes place. Uterine fibroids, polyps, adenomyosis, IUDs, pregnancy complications, carcinomas of uterus and cervix, inherited bleeding disorders, certain medications (estrogens, progestins, anticoagulants, warfarin, enoxaparin) and other medical conditions such as kidney and liver disease may be associated with menorrhagia.

Adolescent girls are prone to menorrhagia due to anovulation especially in the first year after their first menstrual period. It can cause complications like anemia and severe pain along with pale skin, weakness and fatigue.

The treatment options for these conditions mostly depend upon the cause. A detailed history along with certain tests and procedures may be done to confirm the diagnosis and rule out other possible medical conditions.

In case of metrorrhagia medications are used to treat hormone imbalance, infections and other chronic diseases that might lead to metrorrhagia. Surgery is done for polyps, endometriosis and fibroids. Carcinomas of cervix and uterus are managed with surgery chemotherapy radiation or a combination of these procedures. An IUD that may be causing problem should be removed immediately. Ectopic pregnancy and a miscarriage should be given immediate attention and treatment followed by D&C to remove any remaining tissues.

Menorrhagia is confirmed by blood tests, pap smear an endometrial biopsy followed by an ultrasound. Sonohysterography and hysteroscopy will show problems in the inside of the uterus. Treatment options include NSAIDs such as ibuprofen, naproxen sodium that helps reduce menstrual blood flow and relieve menstrual cramps. Tranexamic acid, oral contraceptives, oral progesterone and hormonal IUDs help in regulation of menstrual cycles and reduce episodes of excessive and prolonged bleeding and also relieve menstrual cramps.

Surgical procedures to manage menorrhagia include D&C, uterine artery embolization, focused ultrasound surgery, myomectomy, endometrial ablation, endometrial resection and hysterectomy (removal of uterus) in patients who have completed the family as it is a permanent procedure that causes sterility and ends menstrual periods. Sometimes bilateral oopherectomy (removal of ovaries) is also performed to cause premature menopause.

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Also Read:

• Heavy Menstrual Bleed or Menorrhagia: Causes, Treatment, Home Remedies