At time some women experience excessive bleeding during their menstrual periods. Not only can it cause anemia and related problems, it can also be a warning sign for something graver.
Menorrhagia refers to long and unusually heavy menstruation with a regular cycle. There can be several causes of menorrhagia including abnormal blood clotting, abnormal hormone levels, or endometrium (one of the uterus linings) disorders. Sometimes the heavy periods might also be associated with pain (called dysmenorrhea).
Signs & Symptoms
- The menstruation is heavy enough to force one to change several sanitary pads or tampons on an hourly basis or even faster.
- The bleeding is so heavy that one has to use double pads at the same time.
- One has to wake up during the night in order to change the pads.
- The menstrual bleeding continues for longer than a week.
- Menstrual flow is accompanied by blood clots for more than one day.
- Menstruation becomes a hindrance in your routine activities.
- Since one loses too much blood symptoms of anemia are also experienced. One may feel tiredness, fatigue or shortness of breath.
Blood clotting disorders
Since menstruation requires shedding of endometrium blood vessels, bleeding occurs. Now, if the bleeding is not checked by blood coagulation, the result would be excessive bleed. Platelet disorders, anticoagulant medications like warfarin, coagulation disorders like von Willebrand disease are probable causes.
Disorders related to ovaries-pituitary-hypothalamus hormonal axis are very common causes of menorrhagia. Normally, hormones estrogen and progesterone controls the formation and maintenance of uterine lining called endometrium. An imbalance in hormones may result in excessive endometrium and when it sheds during menstruation it leads to heavy bleeding.
Uterine fibroids are benign tumors (tumors that don’t spread) which may also lead to heavy bleeding.
When ovaries aren’t functioning normally and leads to anovulatory cycles, body doesn’t produce progesterone. Therefore, the hormonal imbalance generated causes menorrhagia.
The endometrial glands embed in the muscles of the uterus. As a result cycles are heavy and painful.
Intrauterine contraceptive devices (IUCD/IUD)
IUCD/IUD is a device placed in the uterus to avoid pregnancy. However, one of the side effects of it is menorrhagia.
Uterine polyps are slight, benign (non-spreading) growth or projections in the uterine lining. They usually occur in women with high levels of hormone while in their reproductive years.
Complications in pregnancy
Sometimes pregnancies go bad leading to miscarriages. The undiagnosed pregnancies are often mistaken for menorrhagia. Nevertheless, miscarriage present later than the normal menstrual dates, and if the bleeding is on regular time, it’s less likely to be a result of it. An ectopic pregnancy (pregnancy occurring outside uterus) may also lead to menorrhagia.
Ovarian cancers, uterine cancers or cervical cancer may also result in menorrhagia.
Sometimes girls at menarche (beginning of menstruations), or women nearing menopause may also experience heavy bleeding. Other causes of menorrhagia include thyroid disorders, pelvic inflammatory disease, or some disease of liver or kidney.
Various risk factors involve obesity, estrogen administration without progesterone, and anovulatory cycles.
Most important complication of menorrhagia is anemia. The heavy blood loss may result in varying degrees of anemia. The symptoms of anemia like shortness of breath and fatigue should be taken seriously.
Also menorrhagia might be accompanied by intolerable pain.
Besides, there might be other complications because of the underlying cause. Thus, treating them alongside taking care of menorrhagia is mandatory.
If one has the symptoms of menorrhagia, i.e. excessive menstrual bleeding an expert consultation from a gynecologist is warranted. It is required to find out the exact cause of menorrhagia and treating it accordingly. Some of the treatment options are as follows (caution: consult your doctor choose the preferred treatment method).
- Iron supplements: Whether you’re anemic or low on iron levels, iron supplements are started. Dosage and period of medication is based upon the iron levels. What you can do at home is eat iron rich diet. Vegetarians can eat green leafy vegetables like spinach, lentils and beans which contains non-heme iron. The options for non-vegetarians are many (and better too containing heme iron) including liver, clams, mollusks, mussels, beef, sardines, turkey, chicken, fish, veal or ham.
- Tranexamic acid: It is taken at the time of menstruation. It helps in reducing blood loss.
- NSAIDS: Not only NSAIDS (Non-Steroidal Anti-inflammatory Drugs) helps in reducing the blood flow, but also help in alleviating pain and cramps of dysmenorrhea. Ibuprofen or naproxen can be used.
- Oral contraceptives: Oral contraceptives regulate menstrual cycles, and also helps in reducing the prolonged and excessive menstrual flow.
- Oral progesterone: Progesterone balances the hormonal imbalance, thus reducing the instances of menorrhagia. These are taken for more than ten days each cycle for relief from menorrhagia.
- Hormonal Intrauterine device: Mirena is an IUD which releases levonorgestrel (a progestin). It thins uterine lining, decreases menstrual flow, and alleviates cramping.
- Uterine artery embolization: This method is used in cases of fibroid. By blocking the uterine arteries, thereby cutting off their blood supply, fibroid size can be shrunk.
- Dilatation and curettage: The cervix is dilated, followed by suctioning or scrapping off some tissue from the uterine lining. It reduces the blood loss during the menstrual flow. This method is suitable for acute or active bleeding. However, for chronic relief repeated D&C might be required.
- Focused ultrasound ablation: This method is also focused at treating menorrhagia caused by fibroids. Ultrasound waves are utilized to destroy the fibroid tissues.
- Endometrial ablation: In this method the endometrium is destroyed completely by the doctors, such that subsequent periods are lighter. However, this method is suitable only for those women who have completed their family, as pregnancy after endometrial ablation is highly risky. Permanent contraception or constant use of reliable contraception is advised.
- Myomectomy: This procedure can be performed either by open abdomen surgery, laparoscopically or hysteroscopically. It’s a treatment for fibroids. The uterine fibroids are removed surgically.
- Endometrial resection: This method is also based on same principle as endometrial ablation. The lining of uterus is destroyed using an electrosurgical wire loop. Like endometrial ablation, pregnancy should be avoided entirely after the procedure.
- Hysterectomy: In this method uterus and cervix are removed surgically. It permanently ends menstruation leading to sterility.
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Apart from the treatments focused on menorrhagia, if there is another underlying cause like a thyroid disorder, it is required to treat those causes first. Sometimes, treating them would treat the menorrhagia automatically without having to do any extra efforts.