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 non-menstrual bleeding from the uterus; bleeding between menstrual periods
postmenopausal bleeding	any bleeding that occurs more than 6 months 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 menstrual period for the first time and in women approaching menopause)

• uterine fibroids, polyps (benign growths in the uterus or uterine lining)

• pelvic inflammatory disease (PID)

• adenomyosis (a condition where cells that typically are found under the uterus are found within the smooth muscle of the uterus; it can cause pain and abnormal bleeding).

• abnormal pregnancy (i.e., miscarriage, ectopic)

• infection, tumors, or polyps in the pelvic cavity

• certain birth control devices (i.e., intrauterine devices, or intrauterine systems)

• 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.

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

How is menorrhagia diagnosed?

Diagnosis begins with a gynecologist evaluating a patient’s medical history and a complete physical examination including a pelvic examination. A diagnosis of menorrhagia can only be certain when the physician 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:

• bleeding diaries

• pregnancy test

• PAD counts

• blood tests, to test for hemoglobin level

• ultrasound (Also called sonography.) - a diagnostic imaging technique which uses sound waves to create images of blood vessels, tissues, and organs. Ultrasounds are used to view organs as they function, and can be used to assess blood flow through various vessels.

• biopsy (endometrial) - a procedure in which tissue samples are removed (with a aspiration device or curette) from the uterine lining for examination under a microscope; to determine if cancer or other abnormal cells are present.

• 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 used to look for polyps or fibroids which may be causing bleeding; often accompanied by dilation and curettage.

• 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 physician 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
• desire for future fertility

Treatment for menorrhagia may include:

• iron supplementation (if the condition is coupled with anemia, a blood disorder caused by a deficiency of red blood cells or hemoglobin)

• prostaglandin inhibitors such as nonsteroidal anti-inflammatory medications (NSAIDs), such as aspirin or ibuprofen (to help reduce cramping and the amount of blood expelled)

• oral contraceptives (ovulation inhibitors)

• 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 - surgical removal of the uterus.