Menorrhagia (Heavy Menstrual Bleeding): Causes and Treatment

Last updated on July 28th, 2018 at 05:22 am

Menorrhagia is the older medical term for heavy menstrual bleeding. Heavy menstrual bleeding is common in women of all age group. Bleeding after menopause is a concern for doctors. It require medical test to rule out any form of cancer.

Menorrhagia is vaginal blood loss more than 80mls during menstruation. However, this is hard to quantify. Your idea of how many pads you change in 2 hours or while sleeping is often used by your doctor to quantify the severity of your bleeding.

Prolonged heavy bleeding in women will cause more menstrual cycles and reduced number of children. In the united kingdom, About 5 percent of women aged between 30 and 49 years consult their doctor for complains of menorrhagia.

What is the normal pattern of menstrual cycle?

Every normal woman in her reproductive years experience regular monthly bleeding. The frequency of a normal menstrual cycle is between 21 to 35 days. The normal duration of your period is between 2 to 7 days. It has been estimated that during your period, It is normal to lose about 25 to 75mls of blood.

However, prolonged cycle with heavy menstrual bleeding more than 80 ml is abnormal. If you experience this, then its important to inform your doctor.

What are the signs and symptoms of menorrhagia?

Menstrual bleeding is sometimes of a concern to women. The presence of these symptoms may suggest menorrhagia.

• Excessive vaginal bleeding with loss of more than 80mls of bloods during your period
• Having to change your sanitary pads more than once at night
• Excessive bleeding that requires changing your pads every 2 hours
• When you experience body weakness, fatigue. This is due to anemia.
• Menstruation that last more than 7 days
• Presence of blood clots that continue for days
• Taking time off your daily activities because of your period.

If you experience any of these heavy bleeding then its important to see your doctor.

What is the cause of heavy menstrual bleeding in women?

Heavy menstrual bleeding in women below 40 years is associated with infertility. However, women more than 40 years will be evaluated for risk of cancer of the cervix or endometrium.

Some of the causes of menorrhagia include

Fibroids. These are tumors that grow in the uterus. They are usually painless. There are different types of fibroids. The fibroid polyp and submucous fibroids can cause severe bleeding in women. Submucous fibroids are beneath the inner covering of the uterus. They may grow to form fibroids polyps which causes bleeding too.

Cervical polyps cause irregular bleeding in women and bleeding during sexual intercourse.

Bleeding disorders in women. This is common in women with unexplained heavy menstrual bleeding. Bleeding disorders can be suspected if

• You have a family history of coagulation disorder
• You had a history of severe bleeding from previous tooth extraction
• Your previous pregnancy was associated with severe bleeding after delivery
• You are bleeding from other parts of our body
• You had a severe bleeding after any surgery in the past.

Von willebrand disease and immune thrombocytopenic purpura are examples of bleeding disorders.

Also, Women taking anticoagulant drugs like warfarin can also have bleeding.

Pelvic inflammatory disease (PID). Infection is a cause of excessive bleeding in women. If you experience experience an unusual vaginal discharge, then its important to see your doctor.

Thyroid diseases can cause bleeding in women. Presence of weight change, skin changes in women with heavy menstrual bleeding will require further test. This is important to rule out any thyroid problems.

Other causes of heavy menstrual bleeding are

• Intrauterine contraceptive device
• Endometriosis
• Adenomyosis
• Atrophic vagina
• Endometrial carcinoma
• Endometrial polyps
• Cervical cancer

How is menorrhagia diagnosed in women?

The presence of the above symptoms is important to make diagnosis. However, some test will be required to identify the cause and severity of the disease. They are

• Full blood count. This will show reduced red blood cell level or hematocrit level. Some women will need blood transfusion. Presence of fatigue, body weakness and breathing problems is likely due to anemia.

• Coagulation test. This is important in women with bleeding disorders.

• Pelvic ultrasound scan. This test is carried out if your menstrual cycle is irregular or a mass is felt during examination of your doctor.

• High vaginal swab or endometrial swabs. If you have abnormal vaginal discharge then this test is important. Infection is detected and treated by your doctor.

• Endometrial biopsy. This is not a routine test for women with menorrhagia. However, women more than 45 years with irregular heavy bleeding will require this test.

• Thyroid function test. If there are thyroid symptoms, your doctor will require this test.

What is the treatment of menorrhagia?

There are 2 types of treatment. Medical and surgical. The medical treatment is temporary while the surgical treatment might not achieve desired fertility.

Medical treatment of heavy menstrual bleeding

Anti inflammatory drugs (NSAIDs). The drug used is mefenamic acid and has shown improvement in women. Blood loss is reduced by 20 to 25 percent. It is the first line treatment for women with bleeding and severe menstrual cramps. However, if you are asthmatic or have duodenal ulcer this drug should be avoided.

Combined oral contraceptive pill. This has been found to be very useful in women. However, it should be avoided in women

• More than 35 years and smoking
• Family history of breast cancer
• Obese or overweight women
• Risk of venous thrombosis

Levonorgestrel intrauterine system. This is highly effective treatment in women heavy bleeding. It reduces blood loss by 95 percent. In addition, it provides extra relief for women that experience painful periods. However, it can cause irregular and breakthrough bleeding.

GnRH agonist. This is gonadotrophin releasing hormone agonist. They act on pituitary gland to stop production of estrogen. This will cause cessation of bleeding. However, when used for long will cause thinning of your bones(Osteoporosis). This is prevented by use of addback hormone replacement therapy (HRT).

Surgical treatment of menstrual bleeding.

This is the next step if medical treatment fails. You will be counselled on fertility issues associated with this treatment. In addition, it is important to complete childbirth before surgical treatment. This is because surgical treatment with endometrial ablation will cause premature babies and abnormal placenta attachment.

Available surgical treatment are

• Endometrial ablation. This involves ablation of the endometrium to prevent it from regenerating
• Hysterectomy.This is removal of the uterus
• Uterine artery embolization. This is a mildly invasive treatment for women who have fibroids. It shrinks fibroids and has been successful in many women.

What are the complications of menorrhagia?

• Emotional stress
• Anemia
• Body weakness
• Death
• Infertility
• Frequent menstrual cycles

Now tell us about your experience. Do you have heavy menstrual bleeding? Share your experience below.