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 Menorrhagia: Causes, Symptoms, Diagnosis, Treatment, Complications & Prevention

Menorrhagia: Heavy Menstrual Bleeding 

Menorrhagia (Heavy Menstrual Bleeding)

Menorrhagia is excessive menstrual blood loss that endures over 7 days. If you need to change your tampon or menstrual pads after under 2 hours or you pass clumps the size of a quarter or bigger, that is considered a heavy menstrual flow.

Blood loss is viewed as unnecessary on the off chance that it surpasses 80 mL for each period, albeit the two ladies themselves and clinicians think that it is hard to unbiasedly measure blood loss. By and by, it is characterized by the lady's emotional evaluation or subjective assessment of blood loss. Any adjustment of the period, regardless of whether genuine or supposed, might be upsetting for social, work-related, or sexual exercises and can prompt different issues including sorrow and worry about an undiscovered issue like a malignant growth. Truly inordinate blood loss will hasten iron insufficiency pallor (hemoglobin <12 g/dL) which, whenever left undiscovered and untreated, will intensify the issues illustrated before.

Assuming a patient has any intermenstrual or postcoital dying, reference to a gynecologist for endometrial biopsy is fundamental to prohibit intrauterine pathology. State-of-the-art cervical cytology is likewise required. It ought to likewise be noticed that hormonal contraceptives might cause some sporadic spotting or advancement dying, however, this is, for the most part, a resistance impact. Non-oral techniques, especially implants, stops, and intrauterine frameworks decline draining with proceeded with use. WHO suggests a 90-day reference period for detailing vaginal bleeding.

Menorrhagia (excessive menstrual blood loss) influences up to 30% of bleeding ladies. The administration of the condition relies on the reason and can be either surgical or medical.

About 30% of ladies complain of heavy menstrual bleeding, and around 1 of every 20 ladies matured 25–44 years counsel their primary care doctors about this issue. All things considered, once alluded to by a gynecologist, 60% of ladies could hope to have a hysterectomy within 5 years. Ongoing changes in the administration of ladies with menorrhagia and new treatment alternatives, especially endometrial removals and the levonorgestrel intrauterine contraceptive devices (LNG-IUS), have essentially decreased hysterectomy rates for menorrhagia to 33% of the number 10 years prior.

Causes Of Menorrhagia

Causes of menorrhagia (percentage frequency):

1. Dysfunctional uterine bleeding (60%), unknown cause
2. Other gynecological causes (30%):
3. Uterine or ovarian tumors
4. Endometriosis
5. Pelvic inflammatory disease
6. Intrauterine contraceptive devices
7. Early pregnancy complications
8. Endocrine and hematological causes (<5%)
9. Thyroid disorders, for example, hypothyroidism
10. Platelet problems and clotting abnormalities

The etiology of menorrhagia can be isolated into three classifications: hidden or underlying pelvic pathology, systemic illness, and dysfunctional uterine bleeding.

Pelvic pathologies related to menorrhagia incorporate myomas (fibroids, normal harmless growths of the myometrium), endometriosis, adenomyosis (entrance of endometrial tissue into the myometrium), endometrial polyps, polycystic ovarian illness, and endometrial carcinoma.

Albeit endometrial malignant growth is all the more regularly seen in postmenopausal ladies, around half of those patients determined to have it premenopausal will have related menorrhagia. Systemic illness from which menorrhagia might stem incorporate hypothyroidism, diseases including the coagulation framework, for example, raised endometrial degrees of plasminogen activator and systemic lupus erythematosus.

Not many ladies fall into this gathering. About 60% of menorrhagia victims have no hidden foundational or pelvic pathology and have ovulatory cycles. These patients are said to have dysfunctional uterine bleeding and local uterine mechanisms give off an impression of being significant in the control of excessive bleeding. Once in a while, cycles might be anovulatory, with weighty blood loss because the endometrium has become hyperplastic and affected by estrogen. What's more, utilization of an intrauterine preventative gadget may likewise increment menstrual blood loss.

Prostaglandins seem to assume a part in the previously mentioned local mechanisms and have been ensnared in menorrhagia. Studies have proposed a relationship between the type and quantity of endometrial prostaglandin combination and the level of feminine blood misfortune. During the 1970s, it was found that ladies with heavy periods had raised endometrial degrees of PGF2α and PGE2 and that blood loss could be diminished by the utilization of medications hindering prostaglandin arrangement.

More investigations recommended that, in menorrhagic ladies, there is a shift towards expanded biosynthesis of PGE2, which is known to widen uterine vasculature and additionally increment the number of film receptors for this prostanoid. The accessibility of arachidonic acid, a substrate for prostaglandin combination, is additionally more prominent in ladies with menorrhagia. Levels of the vasodilators or their metabolites, PGI2 and nitric oxide (NO), are additionally expanded in the menstrual blood gathered from ladies with excessive blood loss.

It has been recommended that menorrhagia is an angiogenesis-related sickness related to changes in the example of vascular delicacy including the upregulation of different vascular endothelial development factors.

Symptoms Of Menorrhagia

The most common symptom of menorrhagia is prolonged heavy bleeding. The bleeding in menorrhagia soaks one or more sanitary pads every hour. If there is a need to use double sanitary pads and menstrual blood contains large blood clots, then it indicates menorrhagia. Menstrual bleeding lasts more than seven days in menorrhagia. Other symptoms reported in menorrhagia are pallor, tiredness, fatigue, shortness of breath​ , and constant pain in the lower stomach.

Symptoms suggestive of underlying pelvic pathology

• Irregular bleeding
• Sudden change in blood loss
• Intermenstrual bleeding
• Postcoital bleeding
• Dyspareunia
• Pelvic pain
• Premenstrual pain

Diagnosis Of Menorrhagia

Unnecessary menstrual blood loss is the most well-known reason for iron inadequacy pallor in ladies of regenerative/reproductive age. In generally sound, well-nourished ladies, it has been assessed that heavy blood loss would need to surpass 120 mL to accelerate iron insufficiency sickliness. Target estimation of heavy blood loss is troublesome, so estimation of full blood count (counting red platelet files and serum ferritin levels), and specifically, hemoglobin focus, gives some signs of blood loss. Thyroid capacity ought to likewise be evaluated. If fibroids are suspected, pelvic ultrasound might be required. Endometrial biopsy is required in case there is a related anomaly of period or on the other hand if intermenstrual or postcoital draining is available.

On account of normal menses, nonetheless, examination of the uterine cavity would typically just be needed in ladies beyond 35 years old years or on the other hand if clinical treatment neglects to reduce manifestations. Young ladies giving broken uterine draining may have basic coagulopathies, for example, von Willebrand's infection or Christmas sickness, which ought to be excluded.

Treatment Of Menorrhagia

The management of menorrhagia relies on the reason for the condition and a lady's desire to conceive. Therapy can be either surgical or medical. The adequacy of medication treatment is affected by the exactness of the diagnosis. Medication treatment is additionally affected by a lady's prophylactic necessities; for instance, COCs can decrease menstrual blood loss by up to half, yet in ladies more than 35 years old who smoke, this type of treatment would require cautious thought. Drugs that are effective in the treatment of menorrhagia are discussed below,

• Progesterone
• GnRH Analogs
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Selective Estrogen Receptor Modulator
• Tranexamic Acid
• Intrauterine Devices (IUDs)

Progesterone

Low-dose luteal-stage progestogens are presently not suggested for the treatment of heavy but regular periods as they increment menstrual blood loss in the present circumstance. In any case, they might be of worth in ladies with a sporadic cycle. Long-acting, long-acting progestogens, be that as it may, may deliver a lady amenorrhoeic.

GnRH Analogs

Other hormonally based treatments incorporate the GnRH analogs, although their penchant to incite a hypo-oestrogenic state with long TERM use might be tricky (a 6-month course would lessen trabecular bone thickness by 5–6%). Danazol can decrease menstrual blood loss however its utilization is, for the most part, restricted close by adverse effects profile.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) by all accounts are best in ladies with the heaviest blood loss, for instance, Mefenamic acid 500 mg multiple times day by day from day 1 until substantial stream stops.

They are used for the reduction of pain and swelling. NSAIDs, such as ibuprofen, or naproxen sodium are effective in reducing menstrual blood loss and painful menstrual cramps (dysmenorrhea).

Selective Estrogen Receptor Modulator

Ormeloxifene, a specific estrogen receptor modulator (like raloxifene), 60 mg twice week after week has been utilized effectively to lessen blood misfortune with moderately barely any incidental effects.

Tranexamic Acid

Ladies with menorrhagia have more prominent endometrial fibrinolytic action, henceforth the utilization of antifibrinolytic drugs, which are plasminogen activator inhibitors. Tranexamic acid is effective in the treatment of menorrhagia. This can be offered to ladies matured 18–45 years of age with a background of regular heavy menstrual bleeding over several consecutive menstrual cycles. Tranexamic acid lessens feminine blood loss by up to half, the suggested dose is 1 g tid every day beginning on the main day of menses for as long as 4 days.

Intrauterine Devices (IUDs)

Your primary care physician can likewise endorse progestin intrauterine devices (IUDs) for the treatment of menorrhagia. This technique is exceptionally compelling for birth control. It is a T-molded gadget that is put in your uterus during a little surgery. It is extremely compelling in treating substantial dying. This intrauterine device will deliver a sort of progestin chemical, levonorgestrel. This chemical results in the diminishing of your uterine coating which diminishes heavy menstrual bleeding.

The levonorgestrel intrauterine contraceptive devices (LNG-IUS) can be placed in your uterus for up to 5 years following addition. They lessen blood loss by up to 90% following a year of utilization. They are effective in the treatment of dysmenorrhoea, successful contraception, and long-term control of menorrhagia.

Surgical Procedures Used For Menorrhagia

If there is no improvement with medicines, then surgery is recommended. The common surgical procedures used are dilation and curettage (D&C), uterine artery embolization, myomectomy, endometrial ablation, and hysterectomy.

Hysterectomy

Hysterectomy has been the conventional surgical treatment for menorrhagia, with either a stomach or vaginal methodology utilized. It is a medical procedure that involves the removal of your uterus and cervix. It is a long-lasting strategy that causes sterility and closure periods. It is performed under sedation and requires hospitalization. Extra evacuation of the ovaries (reciprocal oophorectomy) may cause untimely menopause.

Endometrial Ablation

Fresher options in contrast to hysterectomy incorporate endometrial ablation, which should be possible by electrosurgical, laser, microwave, or warm methods. Endometrial ablation is less intrusive than hysterectomy, yet recurrence of menorrhagia can happen and amenorrhoea can't be ensured. There is proof that pretreatment with a single dose of a GnRH agonist before the removal method gives a superior outcome. These arrangements cause an underlying incitement of gonadotrophin discharge which then, at that point stifles the hypothalamic-pituitary pivot, delivering a hypo-oestrogenic state.

If circling levels of estrogen are low, endometrial development won't be stimulated; in this manner, it will be thinner, making careful endometrial obliteration more powerful. With GnRH pretreatment, present-day methods, for example, microwave removal has accomplished amenorrhoea paces of about half and patient fulfillment paces of 90%.

Dilation And Curettage (D&C)

In this methodology, your primary care physician opens (widens) your cervix and afterward scratches or attractions tissue from the coating of your uterus to decrease menstrual bleeding. Albeit this methodology is normal and regularly treats intense or dynamic draining effectively, you might require extra D&C strategies if menorrhagia repeats.

Uterine Artery Embolization

For ladies whose menorrhagia is brought about by fibroids, the objective of this system is to shrivel any fibroids in the uterus by closing the uterine conduits and removing their blood supply

Myomectomy

This surgical method includes careful expulsion of uterine fibroids. Contingent upon the size, number, and area of the fibroids, your specialist might decide to play out the myomectomy utilizing an open stomach a medical procedure, through a few little entry points, or the vagina and cervix.

Complications Of Menorrhagia

Some potential complications of menorrhagia include:

• Anemia: Heavy menstrual bleeding can lead to iron-deficiency anemia due to the loss of a significant amount of blood over time. Anemia can result in fatigue, weakness, pale skin, and other health issues.
• Interference with Daily Life: Menorrhagia can upset everyday activities and quality of life because of the requirement for regular changes of sanitary products, distress, and the fear of unexpected bleeding.
• Psychological and Emotional Impact: Coping with heavy menstrual bleeding can be emotionally distressing, causing anxiety, depression, and a decreased sense of well-being.
• Impaired Social Life: The need to frequently change sanitary products, along with the fear of leakage, may lead to social withdrawal, reduced participation in social events, and decreased self-esteem.
• Iron Overload: In some cases, individuals with menorrhagia may take excessive iron supplements to combat anemia, which can lead to iron overload and related health problems.
• Medical Intervention: Untreated menorrhagia can result in the need for medical interventions, such as blood transfusions, dilation and curettage (D&C) procedures, or surgery to address the underlying cause.
• Impact on Relationships: Menorrhagia can strain intimate relationships due to sexual discomfort, anxiety about bleeding during intercourse, or avoidance of sexual activity.
• Financial Burden: The cost of sanitary products, medications, doctor visits, and potential medical procedures can create a financial burden for individuals with menorrhagia.
• Reduced Fertility: In some cases, menorrhagia may be associated with underlying conditions, such as uterine fibroids or endometriosis, which can negatively impact fertility.

Prevention Of Menorrhagia 

Preventing menorrhagia (heavy menstrual bleeding) may not always be possible, as it can be caused by various underlying medical conditions. However, certain lifestyle modifications and strategies can help manage and potentially reduce the severity of menorrhagia:

• Maintain a Healthy Weight: Weight can be related to hormonal imbalance causing heavy menstrual bleeding. You should maintain a healthy weight You should keep a healthy weight through a balanced eating regimen and regular exercise.
• Manage Stress: Persistent stress can disturb hormonal balance and deteriorate menstrual symptoms. Stress-reduction techniques like yoga, deep breathing exercises, meditation, and relaxation treatments might help.
• Stay Hydrated: Keep yourself hydrated because dehydration can exacerbate menstrual cramps and discomfort.
• Limit Caffeine and Alcohol: Reducing the consumption of caffeine and alcohol may help alleviate menstrual symptoms for some individuals.
• Healthy Diet: An eating routine rich in natural products, vegetables, entire grains, and lean proteins plays a vital part in overall health and hormonal balance. For example, Iron and vitamin K-rich foods may be beneficial for managing heavy bleeding.
• Regular Exercise: Hormone regulation and general health can both be aided by regular physical activity. For some people, exercise can decrease the severity of menstrual cramps. Nonsteroidal
• Anti-Inflammatory Drugs (NSAIDs): When used as prescribed, over-the-counter NSAIDs, such as ibuprofen, can help lessen menstruation pain and heavy bleeding.
• Hormonal Birth Control: A few types of hormonal contraception prevention, for example, birth control pills, hormonal IUDs, or contraceptive implants, can help regulate and lighten menstrual periods. Talk with a medical care supplier to examine reasonable choices.
• Iron Supplements: If heavy menstrual bleeding leads to anemia (iron-deficiency anemia), iron supplements may be recommended to prevent or treat anemia.
• Medical Evaluation: If you experience heavy menstrual bleeding, it's important to seek medical evaluation to identify and address any underlying causes. Conditions like uterine fibroids, polyps, endometriosis, or hormonal imbalances may require specific treatments.
• Lifestyle Modifications: Lifestyle changes, such as smoking cessation, can also be beneficial, as smoking is associated with worsened menstrual symptoms.

FAQs About Menorrhagia

What is menorrhagia, and how is it defined?

Menorrhagia is used to describe unusually heavy menstrual bleeding. It is defined as menstrual bleeding that lasts longer than seven days or involves excessive blood loss, leading to the need for frequent changes in sanitary products. It can disrupt daily life and may be accompanied by severe menstrual cramps. Menorrhagia is a common gynecological condition that can have various underlying causes and should be evaluated by a healthcare provider.

What are the common causes of menorrhagia?

Menorrhagia can be caused by various factors, including hormonal imbalances, uterine fibroids, polyps, endometriosis, blood clotting disorders, certain medications, and underlying medical conditions.

How is menorrhagia diagnosed? Diagnosis of menorrhagia involves a thorough medical history, physical examination, and often blood tests to check for anemia. Additional diagnostic tests such as ultrasound, hysteroscopy, or endometrial biopsy may be conducted to identify underlying causes.

What are the treatment options for menorrhagia?

Treatment options for menorrhagia include medication (hormonal therapy, nonsteroidal anti-inflammatory drugs), minimally invasive procedures (endometrial ablation), and surgery (hysterectomy). The choice of treatment depends on the underlying cause and individual circumstances.

Is menorrhagia a serious condition, and can it be managed or cured?

Menorrhagia can be a serious condition due to its impact on quality of life and potential complications like anemia. It can often be managed effectively with treatment, but the outcome depends on the underlying cause. While some cases may be cured, others may require ongoing management.