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Menorrhagia is the medical term for menstrual periods with abnormally heavy and prolonged bleeding. Although heavy menstrual bleeding is a common problem, most women do not experience blood loss to qualify as menorrhagia.
With menorrhagia, a woman cannot maintain her usual activities, due to heavy bleeding and pain. This condition cannot be kept silent, it is important to visit your doctor and describe the whole problem. There are many effective treatments for menorrhagia.
Heavy menstruation symptoms
You can talk about heavy menstrual bleeding when you have to replace more than 1 sanitary pad or tampon in an hour. If a woman thinks about hygiene products with enhanced protection (you need to get up at night to carry out regular hygiene procedures), then you need to consult a doctor. Another important symptom is the duration of the menstrual cycle – normally, this period in women lasts from 3 to 7 days, anything above the norm is considered an anomaly that needs to be treated. Other symptoms worth noting include: fatigue; shortness of breath (signs of blood loss, anemia); severe pain that is not affected by painkillers; the presence of a large number of blood clots (more than 2/4 of the total mass of secretions).
Seek medical attention before the next scheduled cycle if a woman experiences: vaginal bleeding so severe that the blood shed is soaked into at least one pad or tampon in less than an hour; bleeding occurs outside the menstrual cycle; with the appearance of any bleeding after the onset of menopause.
Risk Factors
Risk factors change with age, and whether a woman has other medical conditions that may explain menorrhagia. In a normal cycle, the release of an egg from the ovaries stimulates the body to produce progesterone, the female hormone most responsible for maintaining the regularity of menstruation. When an egg is not released, insufficient progesterone can cause heavy menstrual bleeding.
Menorrhagia in adolescent girls (12 to 15 years of age) is usually due to anovulation. They are especially prone to anovulatory cycles in the first year after their first menstrual period (menarche). If girls have this period after 15 years, this may indicate the presence of a pathology, and you need to consult a gynecologist. In adolescence, the abundance of discharge can be affected by: childhood trauma; bronchial asthma; encephalitis; meningitis; heart disease; diabetes. If a girl has bleeding for more than five days (the norm is 3-5 days), it is necessary to consult a gynecologist.
Abundant discharge after an abortion
Abortion is a procedure for the artificial termination of pregnancy. The body has adjusted itself to bear a child, and an abortion requires a sharp restoration of the hormonal background. Usually the first menstrual cycle after the procedure is meager and can be shortened in duration, and the beginning can shift. Since medications are used for the procedure (up to 7 weeks of pregnancy), surgical abortion is performed up to 12 weeks, and in the later stages, for medical reasons, instrumental removal of the fetus. It is a medical type procedure that can result in severe uterine bleeding (very dangerous for a woman). Excessive bleeding after an abortion is not the norm, but a serious problem that needs to be diagnosed and treated.
Menorrhagia in adult women of reproductive age is usually associated with uterine pathology, including fibroids, polyps, and adenomyosis. However, other problems such as uterine cancer, drug side effects, and liver or kidney disease should be ruled out.
Causes of heavy menstruation
In some cases, the cause of heavy menstrual bleeding is unknown, but a number of conditions can cause menorrhagia. Common causes include:
- Hormonal imbalance: In a normal menstrual cycle, the balance between the hormones estrogen and progesterone regulates the buildup of endometrium in the uterus, which is shed during menstruation. If an imbalance of hormones occurs, the endometrium develops in excess and eventually “falls off” through heavy menstrual bleeding. A number of conditions can cause hormone imbalances, including polycystic ovary syndrome (PCOS), obesity, insulin resistance, and thyroid problems.
- Ovarian dysfunction: If the ovaries do not release eggs (ovulation) during the menstrual cycle (anovulation), the woman’s body does not produce the hormone progesterone as it would during a normal menstrual cycle. This leads to an imbalance of hormones and can cause menorrhagia. Ovarian dysfunction is manifested by: opsomenorrhea; hypermenorrhea; dysmenorrhea; proyomenorrhea; hypomenorrhea; metrorrhagia; menorrhagia; algomenorrhea.
- Uterine fibroids: These non-cancerous (benign) tumors of the uterus can cause heavier than normal or prolonged menstrual bleeding.
- Polyps: Small, benign growths on the lining of the uterus (uterine polyps) can cause heavy or prolonged menstrual bleeding.
- Adenomyosis: This condition occurs when the endometrioid tissue, which normally lines only the uterine cavity, becomes overly distributed and embedded in, for example, the muscles of the uterus, often causing heavy bleeding and painful periods.
- Intrauterine device (IUD): Menorrhagia is a known side effect of using a non-hormonal intrauterine device for birth control. Your gynecologist can help you choose a safer alternative contraceptive.
- Pregnancy with complications: one severe late period may be due to a miscarriage, another may be due to heavy bleeding during pregnancy due to an unusual placement of the placenta (low-lying placenta or placenta previa).
- Cancer: Cancer of the uterus and cervix can cause excessive menstrual bleeding, especially if the woman has postmenopausal disease or has had a puncture in the past.
- Menstrual irregularities due to hereditary factors, such as von Willebrand’s disease, a condition in which blood clotting is insufficient or abnormal, can cause abnormal menstrual bleeding.
- Medications: Certain substances, including anti-inflammatory drugs, hormonal drugs such as estrogen and progestins, and anticoagulants such as warfarin (Coumadin, Jantoven) or enoxaparin (Lovenox), can contribute to heavy and prolonged periods.
- Other medical conditions: A number of other medical conditions, including liver or kidney disease, may be associated with menorrhagia.
Complications of prolonged and heavy menstruation
Excessive or prolonged menstrual bleeding can lead to other conditions, including:
- Anemia: Menorrhagia can lead to blood anemia by reducing the number of circulating red blood cells and hemoglobin, a protein that allows red blood cells to carry oxygen to tissues. Iron deficiency anemia occurs when the body attempts to replace lost red blood cells by using iron stores to make more hemoglobin, which can then carry oxygen to organs and tissues. An unpleasant symptom lowers iron levels enough to increase the risk of iron deficiency anemia. Signs and symptoms include pale skin, weakness, and fatigue. Although diet plays a role in the development of iron deficiency anemia, the problem is compounded by heavy menstrual periods.
- Severe pain: along with heavy menstrual bleeding, menstruation can be quite painful (algodysmenorrhea) in the fair sex. Sometimes they are serious, requiring medical evaluation and treatment.
Diagnostics
The gynecologist will likely ask about medical history and menstrual cycles. The patient may be asked to keep a bleeding diary, including notes on how heavy (painful) the bleeding was and how many pads/tampons were used. Modern gynecologists ask their patients to measure the amount of discharge per hour and per day. To do this, you can use the usual scales: weighing each pad / tampon after use (minus the weight of the hygiene product itself) or use a special menstrual cup (sold at any pharmacy or online store). All data is meticulously recorded in a diary. Only in this way the doctor will be able to draw up a complete picture of what is happening.
After the conversation, the specialist will conduct an examination on the gynecological chair, and also examine the condition of the mammary glands, thyroid gland, look for the presence of hirsutism and hypertrichosis (an excess of hair that indicates the presence of hormonal failure). If he has any questions, he can prescribe additional diagnostic procedures and tests, namely:
- a blood test that checks for iron deficiency (anemia) and other conditions such as a thyroid or blood clotting disorder
- Pap test, which collects cells from the cervix and checks for infection, inflammation, or changes that could be cancerous or could lead to cancer
- endometrial biopsy (the doctor takes a sample of tissue inside the uterus for a histologist to examine it);
- ultrasound (this imaging technique uses sound waves to create images of the uterus, ovaries, and pelvis).
Based on the results of the initial tests, the doctor may recommend further testing, including:
- sonohysterography (during this test, fluid is injected through a tube into the uterus through the vagina and cervix, and then the doctor uses ultrasound to look for problems in the uterine lining);
- hysteroscopy (this study, using a special instrument inserted through the vagina and cervix into the uterine cavity, allows you to see the inside of it).
Doctors can be sure of the diagnosis of menorrhagia only after clarifying the causes of menstrual disorders, excluding other diseases, drugs that cause or exacerbate this condition.
In one cycle, women should be allocated up to 100 milliliters of blood. Otherwise, heavy menstruation (menorrhagia) is diagnosed.