Menorrhagia

What is menorrhagia?

Menorrhagia is the most common type of abnormal uterine bleeding characterized by heavy and prolonged menstrual bleeding. In some cases, bleeding may be so severe and relentless that daily activities become interrupted. Other types of abnormal uterine bleeding (also called dysfunctional uterine bleeding) include:

• Polymenorrhea - Too frequent menstruation
• Oligomenorrhea - Infrequent or light menstrual cycles
• Metrorrhagia - Any irregular, acyclic nonmenstrual bleeding from the uterus; bleeding between menstrual periods
• Postmenopausal bleeding - Any bleeding that occurs more than one year after the last normal menstrual period at menopause

What causes menorrhagia?

There are several possible causes of menorrhagia, including the following:

• Hormonal (particularly estrogen and progesterone) imbalance (especially seen in adolescents who are experiencing their first menstrual period and in women approaching menopause)
• Pelvic inflammatory disease 
• Uterine fibroids
• Abnormal pregnancy (i.e., miscarriage, ectopic)
• Infection, tumors, or polyps in the pelvic cavity
• Certain birth control devices (i.e., intrauterine devices, or IUDs)
• Bleeding or platelet disorders
• High levels of prostaglandins (chemical substances which help to control the muscle contractions of the uterus)
• High levels of endothelins (chemical substances which help the blood vessels in the body dilate)
• Liver, kidney, or thyroid disease

What are the symptoms of menorrhagia?

In general, bleeding is considered excessive when a woman soaks through enough sanitary products (sanitary napkins or tampons) to require changing every hour. In addition, bleeding is considered prolonged when a woman experiences a menstrual period that lasts longer than seven days in duration. The following are the most common (other) symptoms of menorrhagia. However, each individual may experience symptoms differently. Symptoms may include:

• Spotting or bleeding between menstrual periods
• Spotting or bleeding during pregnancy

The symptoms of menorrhagia may resemble other menstrual conditions or medical problems. Always consult your health care provider for a diagnosis.

How is menorrhagia diagnosed?

Diagnosis begins with a health care provider evaluating a woman’s medical history and a complete physical examination including a pelvic examination. A diagnosis of menorrhagia can only be certain when the health care provider rules out other menstrual disorders, medical conditions, or medications that may be causing or aggravating the condition. Other diagnostic procedures for menorrhagia may include the following:

• Blood tests
• Pap test. A test that involves microscopic examination of cells collected from the cervix; used to detect changes that may be cancerous or may lead to cancer, and to show noncancerous conditions, such as an infection or inflammation.
• Ultrasound (also called sonography)
• Biopsy (endometrial). A procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present. An endometrial biopsy removes tissue from the lining of the uterus. 
• Hysteroscopy. A visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.
• Dilation and curettage (D & C). A common gynecological surgery which consists of widening the cervical canal with a dilator and scraping the uterine cavity with a curette.

Treatment for menorrhagia

Specific treatment for menorrhagia will be determined by your health care provider based on:

• Your age, overall health, and medical history
• Extent of the condition
• Cause of the condition
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition
• Your opinion or preference

Treatment for menorrhagia may include:

• Iron supplementation. This treatment is used if the condition is coupled with anemia, a blood disorder caused by a deficiency of red blood cells or hemoglobin.
• Prostaglandin inhibitors. These are nonsteroidal anti-inflammatory medications, including aspirin or ibuprofen, which help reduce cramping and the amount of blood expelled.
• Oral contraceptives. These inhibit ovulation.
• Progesterone. Hormone treatment.
• Endometrial ablation. A procedure to destroy the lining of the uterus (endometrium).
• Endometrial resection. A procedure to remove the lining of the uterus (endometrium).
• Hysterectomy. A surgical removal of the uterus.