Menorrhagia: Causes, Symptoms, and Treatment

Do you experience unusually heavy menstrual bleeding? If so, you may have a condition known as menorrhagia. Learn more about what causes this excessive bleeding and the treatments available for the condition.

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Menorrhagia is a prolonged and excessively heavy menstrual bleeding at regular menstrual cycle intervals. Although several factors (e.g. anatomical defects or growths in the womb, blood component abnormality, or hormonal imbalance) may be implicated, the cause of the abnormal uterine bleeding is often unknown.

What is a Normal Menstrual Cycle?

The menstrual cycle is not the same for every woman. A normal menstrual cycle occurs about every 28 days and lasts about five days. On average, the menstrual flow is between 30–40ml of blood loss. Variation in the amount and duration of blood loss during a menstrual period is medically less significant than bleeding, pain, or discharge between periods.

Other types of abnormal uterine bleeding are too-frequent menstrual periods, bleeding between periods, and bleeding after menopause.

Vaginal bleeding may be something to worry about for women if it occurs post-menopause (over 50 years old). The risk of malignancy increases with age.​

Menorrhagia Causes

In a normal menstrual cycle, there is a balance between oestrogen and progesterone. These are hormones in the body that help regulate the build-up of the endometrium (uterine inner lining), which is shed each month during menstruation.

For menorrhagia, there may be an imbalance in oestrogen and progesterone levels. As a result of the imbalance, the endometrium develops in excess. When it is eventually shed, there is heavy menstrual bleeding. As hormone imbalances are often seen in adolescents and women approaching menopause, this type of menorrhagia is fairly common in these groups.

Another frequent cause of menorrhagia is uterine fibroids (growths). Other causes include:
Endometrial cancer
Inflammation or infection of the vagina, cervix, or pelvic organs
Polyps (small growths on the cervical or uterine wall)
Thyroid conditions
Liver, kidney, or blood disease, and the use of blood-thinning drugs

It is recommended that you see your gynaecologist if your period lasts more than seven days and/or if your periods are less than 21 days apart (unless that's your regular menstrual cycle). Your doctor will probably ask about your past health and menstrual patterns, conduct a pelvic exam (examination of the internal reproductive organs), do a Pap smear, and other tests.

You may require other tests to rule out pregnancy (if you are sexually active), and urinary and gastrointestinal tract problems. You may also undergo investigations to determine whether you are ovulating or have any sexually transmitted diseases.

Although cancer is not a frequent cause of menorrhagia, it should be ruled out in older women (aged 35 to 40) or in younger women with longer duration of exposure to unopposed oestrogen.

Menorrhagia: Symptoms and Signs

You may be experiencing menorrhagia if you have the following:
Menstrual flow that soaks through one or more sanitary pads every hour
The need to use double sanitary protection to control your menstrual flow
Menstrual period that lasts more than seven days
Menstrual flow that includes large blood clots

Excessive and prolonged menses may lead to anaemia, which causes:
Pallor
Tiredness
Fatigue
Shortness of breath​

Menorrhagia: Treatment 

Treatment for menorrhagia depends on the cause or the underlying medical condition.
Polyps are generally removed; fibroids may require a myomectomy or hysterectomy (surgical removal of uterus and cervix).
Hysterectomy and radiation are usually considered for endometrial cancer.
A hormonal imbalance may require hormonal treatment.

Self-care

Bed rest may be recommended if bleeding is heavy.
Record the number of pads or tampons you have used so that your doctor can determine the amount of bleeding. Change tampons regularly, at least twice a day.
See your gynaecologist if symptoms persist.​  

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