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Menorrhagia: Causes, Symptoms, Diagnosis, and Management
Introduction
Menstruation is a natural physiological process that occurs in women of reproductive age. While it is normal to experience monthly bleeding, excessive or abnormally heavy bleeding can indicate an underlying medical condition. Menorrhagia is the medical term for unusually heavy or prolonged menstrual bleeding that interferes with a woman’s quality of life. It is one of the most common gynecological complaints, affecting millions of women worldwide.
This article explores the definition, causes, symptoms, diagnosis, and management of menorrhagia.
Definition
Menorrhagia is defined as excessive menstrual blood loss that:
- Lasts more than 7 days, or
- Involves blood loss greater than 80 mL per cycle, or
- Requires changing sanitary pads or tampons every 1–2 hours, or
- Leads to anemia and disruption of daily activities.
It is important to differentiate menorrhagia from other menstrual disorders such as oligomenorrhea (infrequent bleeding) or polymenorrhea (frequent cycles).
Causes of Menorrhagia
Menorrhagia can be caused by a variety of conditions. The underlying causes can be grouped as:
1. Uterine Causes
- Fibroids: Benign growths in the uterus that increase bleeding surface.
- Polyps: Small overgrowths in the uterine lining.
- Adenomyosis: Uterine wall thickening leading to painful and heavy periods.
- Endometrial hyperplasia: Thickening of the uterine lining due to excess estrogen.
- Uterine cancer (rare but serious cause).
2. Hormonal Imbalances
- Lack of proper ovulation may lead to prolonged estrogen stimulation without progesterone balance, causing endometrial overgrowth and heavy bleeding.
- Seen commonly in adolescents and women approaching menopause.
3. Systemic Conditions
- Blood clotting disorders (e.g., Von Willebrand disease, platelet dysfunction).
- Thyroid disorders (both hyperthyroidism and hypothyroidism).
- Liver or kidney disease.
4. Iatrogenic Causes
- Intrauterine devices (IUDs), especially copper IUDs.
- Medications such as anticoagulants, hormonal therapies, or chemotherapy.
Symptoms of Menorrhagia
Common symptoms include:
- Menstrual bleeding lasting longer than 7 days.
- Passing large blood clots during menstruation.
- Needing to change pads or tampons every 1–2 hours.
- Bleeding that interferes with normal daily activities.
- Symptoms of anemia: fatigue, weakness, dizziness, or shortness of breath.
Complications of Menorrhagia
If untreated, menorrhagia can lead to:
- Iron-deficiency anemia, causing weakness and pale skin.
- Severe fatigue affecting work and social life.
- Fertility issues in some cases.
- Emotional distress and reduced quality of life.
Diagnosis of Menorrhagia
Diagnosis requires a detailed medical history, clinical examination, and investigations:
History
- Age, menstrual cycle pattern, duration, flow intensity.
- Family history of bleeding disorders.
- Use of medications or contraceptives.
Examination
- General examination: signs of anemia, thyroid problems.
- Pelvic examination: uterine size, tenderness, masses.
Investigations
- Complete blood count (CBC): To check for anemia.
- Thyroid function tests.
- Coagulation profile: To rule out bleeding disorders.
- Pelvic ultrasound: To detect fibroids, polyps, adenomyosis.
- Endometrial biopsy: To exclude cancer or hyperplasia in women over 40 or with risk factors.
Management of Menorrhagia
Treatment depends on the underlying cause, severity, age, and desire for future fertility.
1. Medical Management
- Non-steroidal anti-inflammatory drugs (NSAIDs): Reduce bleeding and pain.
- Tranexamic acid: Reduces blood loss by promoting clotting.
- Hormonal therapy:
- Combined oral contraceptives.
- Progesterone-only pills or injections.
- Levonorgestrel-releasing intrauterine system (LNG-IUS).
2. Surgical Management
- Endometrial ablation: Destruction of uterine lining to reduce bleeding.
- Myomectomy: Removal of fibroids while preserving fertility.
- Hysterectomy: Complete removal of the uterus, reserved for severe cases not responding to other treatments.
Prevention and Self-Care
- Maintaining a healthy diet rich in iron and vitamins to prevent anemia.
- Monitoring menstrual cycles and seeking medical care for abnormalities.
- Regular gynecological checkups for early detection of underlying conditions.
Prognosis
With appropriate diagnosis and treatment, most women with menorrhagia can manage their symptoms effectively and live a normal life. Early medical consultation is key to preventing complications.
Conclusion
Menorrhagia is a common but often underreported condition that can significantly impact a woman’s physical, emotional, and social well-being. While heavy menstrual bleeding may sometimes be normal, persistent or severe symptoms should never be ignored. Advances in medical and surgical treatments now provide multiple options, allowing women to choose the best approach tailored to their lifestyle and reproductive goals.
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