Menorrhagia

Definition

Menorrhagia is excessive and/or prolonged menstrual bleeding. Although about 30% of women have heavy periods, only 10% of women have Menorrhagia. On average, menstrual flow occurs every 28 days and lasts for 5 days. Four tablespoons to 1 cup (60 to 250 milliliters) of blood is lost during this time.

Causes

In some cases the cause of Menorrhagia is unknown. However, many conditions have been known to cause Menorrhagia. These include:
  • Hormone imbalance (the most common cause)
  • Pelvic inflammatory disease (PID)
  • Cervical or endometrial polyps
  • Uterine fibroids
  • Infection
  • Bleeding or platelet disorders
  • Liver, kidney, or thyroid disease
  • Problems with an intrauterine device (IUD)
  • Ectopic pregnancy
  • Ovarian dysfunction
  • Ovarian cysts
  • Chronic medical conditions
  • Anticoagulant and anti-inflammatory medications
  • Cancer of the uterus or cervix (rare causes)

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition. People at greatest risk for Menorrhagia include:
  • Adolescent girls who have started menstruation within the last 12-18 months
  • Women approaching menopause
  • Women with hereditary bleeding disorders
  • Women who are obese

Symptoms

Symptoms of Menorrhagia include:
  • Menstrual bleeding lasts more than seven days
  • Unusually heavy bleeding (soaking through a sanitary napkin or tampon every hour)
  • Menstrual flow requires change of sanitary protection during the night
  • Menstrual flow includes large clots
  • Menstrual flow interferes with lifestyle
  • Fatigue and/or shortness of breath (symptoms of anemia)

Diagnosis

Your doctor will ask about your symptoms and medical history and perform a physical exam, including a pelvic exam. The first step will be to determine the cause of the bleeding. Tests may include:
  • Pap test
  • Blood tests
  • Pregnancy test
  • Ultrasound – a test that uses sound waves to examine your reproductive organs
  • Endometrial biopsy – removal of a sample of endometrial tissue to check for cell abnormalities
  • Dilation and curettage (D & C) – scraping of the inner lining of the uterus
  • Hysteroscopy – examination of the cervix and fallopian tubes using a telescope-like viewing device

Treatment

Treatment of Menorrhagia will depend on the underlying cause. Women who experience persistent excessive bleeding should take iron supplements to prevent anemia.
If there is no medical disorder causing your Menorrhagia, your doctor may prescribe the following:
Medication
These may include:
  • Hormone therapy
  • Non-steroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
Surgical Procedures
Procedures may include:
  • Dilation and curettage (D&C) – the cervix is dilated and the lining of the uterus scraped to remove uterine tissue.
  • Operative hysteroscopy – a long, thin instrument is inserted into the uterus that can aid in removal of a polyp.
  • Endometrial ablation or resection – removal of the lining of the uterus.
  • Hysterectomy – the surgical removal of the uterus. After this procedure, a woman is unable to become pregnant. If the ovaries are also removed, it will cause early menopause.

Prevention

For most women there are no specific steps for prevention. However, if your Menorrhagia is caused by a medication, you may prevent the condition by stopping use of this medicine. Also, avoid taking aspirin as this may prolong bleeding. Menstrual discomfort is better treated with pain relievers such as Motrin and Advil.