All About Menorrhagia
What Is Menorrhagia?
Menorrhagia is prolonged and sometimes painful menstrual bleeding, which can effect daily life, cause social embarrassment, restrict activities (including intimacy) and dampen a sense of wellbeing. It occurs at regular menstrual cycle intervals. It is the most common gynecologic complaint and the basis for a majority of hysterectomies (removal of the uterus) performed. It is estimated that an average of one-in-five women between the ages of 35 and 49 seek a physician’s help for heavy menstrual bleeding. As a result of this condition, nearly 30% of women reporting such problems spend one or more days in bed per year.
Symptoms of Menorrhagia
Menstrual bleeding is considered excessive when a woman soaks through sanitary products that require changing every hour. During normal menstruation women lose about 2 ounces (60mL) of blood or less. Menorrhagia is defined as total blood loss exceeding 80mL per cycle and lasting greater than 7-9 days. Normal menstrual cycle is 21-35 days in duration, with bleeding lasting an average of 7 days. Clot formation is fairly common during heavy bleeding and is not an automatic cause for concern).
What Causes Menorrhagia?
Not all of the reported incidents of menorrhagia have a determinable cause. However, there are several possible causes of menorrhagia, including pelvic inflammatory disease (PID), uterine fibroids or polyps, a retroverted uterus (tipped uterus) abnormal pregnancy, bleeding disorders, uterine cancer, infection, certain medications and birth control devices (IUD’s). Any woman who has not had a hysterectomy and who complains of excessive menstrual bleeding should first undergo a pelvic exam to rule out pregnancy-associated conditions or abnormalities, such as ovarian cysts or fibroids. Fibroids or polyps can alter the shape and texture of the uterine wall or endometrium (uterine lining), which is shed each month during menstruation. A physician will also examine a patient to eliminate a variety of underlying conditions, including cancer.
Menorrhagia may also be caused by a hormonal imbalance which can affect the buildup or overgrowth of the endometrium (endometriosis) both in- and outside of the uterus. As a result, the thick endometrial growth can contribute to heavy bleeding when shed during menstruation.
Diagnosing Menorrhagia
It is generally difficult to diagnose menorrhagia, since the measurement of menstrual blood loss is not an exact science. Various diagnostic procedures to target menorrhagia’s cause or causes include:
- Dilatation and curettage (D&C) involves the cervix (neck of the uterus) being opened (dilated) and the surgeon scraping the inside lining of the uterus and cervix. This procedure is used to take samples of the tissue and to relieve heavy bleeding in some instances A significant portion of endometrial lesions are not detected by D&C, which involves a general anesthetic and one-day hospital stay. Risks include possible uterine perforation and laceration of the cervix.
- Endometrial biopsy uses an intrauterine catheter to scrape or brush the endometrial surface.
- Hysteroscopy uses a fiber optic light inserted into the uterus to view the cavity on a video screen and enables a targeted biopsy of abnormal endometrium. It may be used to detect the presence of fibroids, polyps or other causes of bleeding. It may miss cases of uterine cancer and is not a substitute for more invasive procedures, such as D&C or endometrial biopsy. This procedure is ambulatory and does not require general anesthesia.
- Vaginal sonography, which uses sound waves to produce organ images, is the standard technique for evaluating the uterus and ovaries, detecting fibroids, ovarian cysts and tumors and is used to determine the accuracy of clinical diagnosis and treatment options.
- Magnetic resonance imaging (MRI) presents a clearer image of any fibroids that might be causing heavy bleeding.
Menorrhagia and Anemia
Patients who lose more than 80mL of blood (greater than six-to-eight teaspoons) each cycle are at risk of developing iron-deficiency anemia. Menstrual bleeding during menorrhagia may involve clots or thicker than normal blood, and may result in anemia (lack of sufficient red blood cells). If the bleeding is severe enough, a woman may experience shortness of breath, fatigue, palpitations and other related symptoms. .
Toxic Shock Syndrome and Infection
Women with menorrhagia who insert two sanitary products at a time (not advised to do so) may increase their risk of infection. Toxic Shock Syndrome (TSS) is a potentially life-threatening condition caused by bacteria that adhere to tampons, which, if left unattended, can produce life threatening toxins.
Treatment Options for Menorrhagia
Women suffering from menorrhagia have medical and surgical options available to them
- Hormone therapy, including oral contraception, can result in less bleeding. Hormone treatments in the form of injections or tablets are also available and can stop menstrual bleeding. Treatment usually lasts three-to-six months (short-term), but the symptoms generally return six months after treatment is discontinued. Side effects include those associated with induced menopause.
- Endometrial ablation is a procedure where the lining of the uterus is removed using either electricity, heat, freezing or microwave energy. Side effects include cramping and pain, which can be relieved with over-the-counter painkillers and frequent urination. A hysteroscope is used to view the uterine cavity for standard endometrial ablation. It is considered effective in reducing bleeding.
- Endometrial resection requires the use of a resectoscope (tubular instrument) with a heated wire loop or a tiny surgical blade to remove the lining of the uterus. Primary risk is uterine perforation
- Hysterectomy is the surgical removal of the uterus and provides the definitive treatment for menorrhagia. This procedure is recommended for women with a large uterus, severe endometriosis or if there is an increased risk of uterine cancer (e.g., family history). The uterus and cervix may be removed either through an abdominal incision or through the vagina. Abdominal hysterectomy requires anesthesia, three-to-six days in the hospital and up to six weeks recovery time. Risks include uterine perforation, hemorrhage and cervical constriction. Side effects include an end to childbearing.
- Myomectomy is a surgical procedure which removes fibroids through an abdominal incision, while leaving the uterus intact. It is considered a surgical option for women who wish to maintain their fertility. The average hospital stay is four-to-five days. Side effects involve a high rate of adhesions (scar tissue causing internal organs to bind together) and pain
- Laparoscopic myomectomy is a minimally invasive technique. It involves a thin lit telescope threaded through small incisions in the bellybutton and abdomen to view the uterus, ovaries and fallopian tubes. The fibroid material is then cut and removed. This procedure leaves no visible surgery scars and allows patients to recover faster, suffer less pain and return home the same day.
Heavy menstrual bleeding is a subjective finding, making the exact problem’s definition difficult. An approximate assessment of blood loss can be made from a pad and tampon count. Therefore, the physician will address the specific aspect of the menstrual cycle the patient perceives as abnormal.
All treatment options for menorrhagia must be discussed with a physician. However, it is important for a woman to understand that this common disease does not have to control one’s quality of life forever. |
