Menorrhagia

Menstrual bleeding is said to be heavy when the quality of life is hampered. Many females facing heavy menstrual periods can be inconvenient and uncomfortable. They have witnessed family members having heavy periods without seeking care and they usually follow their example. However, periods are not supposed to restrict activities or accept inconvenience.

During your period, you should be able to:

• Wear a single menstrual product without having to double-up at any point.
• Wear a tampon or standard pad every 3-4 hours without changing it.
• Leave your home without having to pack clothing changes or pack extra bags of pads.
• Live your life normally avoiding going out in public, without missing work, or shipping activities you enjoy.
• If your menstrual cycle interferes with your life, you must see your healthcare provider.

Symptoms of Menorrhagia

Here are some signs and symptoms associated with menorrhagia:

• Use of double sanitary pads to control your menstrual flow
• Changing multiple sanitary pads in one day while having periods
• Menstruation occurs for more than a week
• Feeling the need to wake up during the night to change the sanitary pad
• Restriction of everyday activities because of heavy menstrual flow
• Passage of large blood clots with the menstrual blood
• Anaemia symptoms include fatigue or shortness of breath

You must look for immediate medical care and attention if you face any of the following:

• Extremely heavy vaginal bleeding so that it soaks one pad in an hour for more than two hours
• Irregular vaginal bleeding or bleeding in between periods
• Postmenopausal vaginal bleeding

Causes

While the reason for heavy menstrual bleeding is unknown in some cases, here are some causes behind this condition:

• Hormonal imbalance
  A balance between the hormones progesterone and oestrogen in a normal menstrual cycle regulates the lining of the uterus called the endometrium, which normally sheds at the time of menstruation. A hormonal imbalance can cause extra endometrium to grow and subsequently shed off as excessive menstrual flow. Numerous medical diseases, such as obesity, polycystic ovarian syndrome, thyroid problems, and insulin resistance, can lead to hormonal imbalance.
• Dysfunction of the ovaries
  If the ovaries lose the function to ovulate or produce eggs during a menstrual cycle, the hormone progesterone is not created in the body as it would normally do. This may result in hormonal imbalance and, consequently, menorrhagia.
• Fibroids in the uterus
  These are benign tumours of the uterus that usually appear in females during their reproductive years. Because of uterine fibroids, a heavier or prolonged menstrual period than normal may be experienced.
• Polyps
  Uterine polyps are small, benign growths on the uterine lining that result in heavy or prolonged menstrual bleeding.
• Adenomyosis
  This occurs when the endometrial glands get embedded in the muscles of the uterus, often leading to painful periods and heavy bleeding.
• Intrauterine device (IUD)
  Menorrhagia is a well-known side effect of a non-hormonal intrauterine device used for birth control. Your doctor will devise plans for alternative management options.
• Pregnancy complications
  Miscarriage may lead to a single, heavy, late period. Another reason for heavy bleeding in pregnant females may also be an abnormally placed placenta.
• Cancer
  Excessive menstrual bleeding can also occur if there is uterine or cervical cancer, especially in post-menopausal women.
• Inherited bleeding disorders
  Few bleeding disorders like von Willebrand's disease can cause abnormal menstrual bleeding.
• Medications
  Certain types of medications like anti-inflammatory medications, hormonal medications such as progestins and oestrogen, and anticoagulants such as warfarin or enoxaparin can give rise to prolonged or heavy menstrual bleeding.
• Other medical conditions
  There are several other medical conditions like kidney or liver diseases that are associated with menorrhagia.

Your doctor will perform a physical and a pelvic exam to diagnose the problem. Many procedures that are non-invasive are available to help diagnose your problem. Those tests include:

• Hysteroscopy
  A hysteroscopy can be performed to look for fibroids, polyps, or other irregular uterine tissue. Hysteroscopy lets the doctor inspect the cervix, vagina, and uterus. During a hysteroscopy, your healthcare provider can remove growths that may be causing your bleeding such as polyps or fibroids.
• Sonohysterogram
  A sonohysterogram can be used to check for problems in the uterine lining. This test allows your healthcare provider to visualise the internal structures of the uterus after it’s filled up with saline. It offers excellent sensitivity and accuracy when looking for abnormalities in the uterine cavity than a USG without saline.

You may also have other tests, depending on the severity of your symptoms and your age. Other tests may include:

• Blood test
  A blood test may be performed to look for signs of clotting issues, anaemia, or thyroid disease.
• Pap smear
  This test is used to study cervical cells for changes that may point towards cancer.
• Endometrial biopsy
  This test is used to check uterine tissue for malignant cells and other abnormalities.
• Transvaginal ultrasound
  This test is performed to check the appearance of tissues and organs in the pelvic area.
• Magnetic resonance imaging (MRI)
  It helps to look for abnormalities inside the uterus when an ultrasound does not provide adequate information.
• Cervical culture test
  This test is used to detect infection, as indicated by the results of physical examination and medical history.

Diagnosis

A few questions about your medical history and menstrual cycles will be asked by your doctor. You must maintain notes of your menstrual flow details such as how many days it lasted, how many sanitary pads you would change in one day and how was the flow. Further, a complete physical examination will be done by your doctor, and some tests will also be recommended:

• Blood test
  Your blood sample may be evaluated for iron deficiency anaemia and several other conditions, including thyroid disorders or blood clotting disorders.
• Pap test
  Cells from your cervix are taken in this test and tested for any signs of infection or cancerous changes.
• Endometrial biopsy
  A sample from the inside of the uterus is collected and sent for histopathological examination.
• Ultrasound
  During this imaging method, ultrasounds are used to produce images of the ovaries, uterus, and pelvis. Depending on the results of your initial investigation reports, further testing, including the following, may be recommended:
• Sonohysterography
  A fluid is injected into the uterus through a tube during this test. Then ultrasound is done to look for any abnormalities in the lining of the uterus.
• Hysteroscopy
  During this examination, a thin instrument with a camera is inserted into the uterus through the cervix and vagina, which helps the doctor visualise the inside of the uterus

A certain diagnosis of menorrhagia can be established only after ruling out other medical conditions, menstrual disorders, or medications that are possible triggers of the condition.

Treatment

Treatment of menorrhagia depends on the cause of the bleeding, its severity, your age, health, and medical history. The treatment also depends on your preferences and response to certain medications. For example, you may desire to not have periods at all or to reduce the menstrual flow. Additionally, your future pregnancy plans may affect your treatment options. You can talk about your health concerns and treatment goals with your healthcare provider.

Medications

Your doctor may prescribe certain medications to treat your heavy menstrual bleeding. These include iron supplements and some other medicines. Some procedures can also be used to treat menorrhagia. Those include:

• Hysteroscopy
  It can be used to diagnose and treat menorrhagia. During an operative hysterectomy, the doctor introduces a narrow, lighted tube into the vagina that allows them to examine the inside of the uterine cavity. The hysteroscope can be used as a precise surgical instrument that helps doctors remove any growths that may be the reason for your bleeding.

Other procedures include:

• Myomectomy
  It is a procedure that can be used to remove uterine fibroids.
• Uterine artery embolization (UAE)
  It is the procedure that is used to restrict blood flow from tumours and fibroids.
• Endometrial ablation
  During this procedure, all or part of the uterine lining is removed. Your doctor may often recommend a sterilisation afterwards. Endometrial ablation makes the foetus susceptible to risk of serious complications if the female becomes pregnant.
• Hysterectomy
  This surgery is used to remove the uterus and prevent you from getting pregnant or having periods.

Treatment of Menorrhagia

You must talk to your doctors if you notice symptoms of anaemia or heavy menstrual bleeding, or if your bleeding has turned abnormal. Tracking your periods using an app or a calendar can help you identify if your periods are longer-lasting and heavier than usual. You must also schedule an appointment with your doctor if you experience having to use double menstrual products or are skipping activities you enjoy because of heavy menstrual bleeding. Doctors at our Department of Gynaecology and Obstetrics help treat and manage menorrhagia. Consult the best gynaecologists in Indore to help treat menorrhagia at our department.