MENORRHAGIA (HEAVY MENSTRUATIONS)
Heavy menstruations (menorrhagia) are not rare, but may cause troubles. Menorrhagia symptoms include long, heavy menses with blood cloths. Menorrhagia treatment depends on many individual factors and is usually prescribed personally to each patient. What is considered to be normal menstruations, what are the complications of menorrhagia and what are the treatments for this condition – all these and some other questions are reviewed below.
Menorrhagia is a medical term used in describing menstrual periods with abnormally heavy or prolonged bleeding. Most women do not experience severe blood loss for it to be called menorrhagia; it is a common case in premenopausal women. With menorrhagia, every period had comes with enough blood loss and cramping which can lead to a disruption in daily activities.
WHAT IS A REGULAR MENSTRUAL CYCLE?
The regular menstrual cycle has a blood loss for seven days of a cycle between 21 and 35 days. The mathematical explanation for this is: K=7⁄((21-35))
- K = represents menstrual cycle
- 7 = duration of bleeding
- 21 – 35 = represents length of the cycle
The regular menstrual blood loss is about 30 – 40ml, women who complain of heavy menstruations do not actually have blood loss surplus of 80ml. A more practical definition of menorrhagia may be given as that in which blood loss is greater that which the woman feels she can withstand. According to The National Institute for Health and Care Excellence, menorrhagia (heavy menstrual loss) is defined as excessive blood loss that interferes with a woman’s physical, emotional, social and or quality of life.
Signs and symptoms of heavy menstruations may include:
- Soaking through one or more sanitary pads or tampons every hour for several consecutive hours.
- Need to use double sanitary protection to control menstrual flow.
- Need to wake up to change sanitary protection during the night.
- Bleeding for longer than a week.
- Passing blood clots with menstrual flow for more than one day.
- Restricting daily activities due to heavy menstrual flow.
- Symptoms of anaemia such as tiredness, fatigue or shortness of breath.
Complications of Menorrhagia has the ability to lead to other conditions namely:
- Iron deficiency anaemia: This is a common type of anaemia where the haemoglobin is low in the blood, a substance that allows oxygen be carried by the red blood cells to tissues. Low haemoglobin could be as a result of insufficient iron. Excessive bleeding may decrease iron levels to a level where there is the risk of iron deficiency anaemia. Symptoms include pale skin, weakness and fatigue. Diet also plays a role in iron deficiency which could be complicated due to heavy bleeding.
Most cases of anaemia are mild though it may lead to weakness and fatigue while moderate to severe cases of anaemia lead to shortness of breath, rapid heart rate, dizziness and headaches.
- Severe pain: Excessive bleeding is also accompanied with severe menstrual pain known as dysmenorrhea. At times these menstrual cramps are so severe that medication or surgery may be required.
MENORRHAGIA TREATMENT OPTIONS
The treatment of heavy menstruations can be based on a number of factors which include:
- Overall health and medical history.
- Cause and severity of the condition.
- Tolerance for explicit medications, procedures or therapies.
- Future childbearing plans.
- Effects of specific lifestyle.
- Personal preference.
Possible treatments for menorrhagia include:
- Iron supplements: Iron supplements are recommended to those who may be anaemic by the doctor. They are also recommended to those who have low levels of iron so as to not develop anaemia.
- Non-steroidal anti-inflammatory drugs (NSAIDs): These drugs such as ibuprofen (Advil, Motrin IB) or naproxen (Aleve), help in reducing menstrual blood loss and they have the added benefit in relieving painful menstrual cramps.
- Tranexamic acid: This is another treatment option which helps in reducing menstrual blood loss that only needs to be taken during menstrual periods.
- Oral contraceptives: Apart from aiding in birth control, oral contraceptives also help in regulating menstrual periods and reducing occurrence of menorrhagia.
- Oral progesterone: This aids in correcting hormone imbalance and reducing menorrhagia when taken for 10 or more days.
- Hormonal IUD (Mirena): This works by releasing a type of progestin called levenorgestrel from the intrauterine device which makes the uterine lining thin thereby decreasing menstrual blood flow and cramping.
Where drug therapy is not successful, surgical treatment may be of option, they include:
- Dilation and Curettage (D&C): The procedure involves the opening (dilating) of the cervix and the scraping or suctioning of the tissue from the lining of the uterus to reduce menstrual bleeding. On recurrence of menorrhagia, additional D&C procedures may be needed.
- Uterine artery embolization: This treatment is used in women whose condition is caused by fibroids; the objective of this procedure is to shrink any fibroids in the uterus by blocking the uterine arteries and cutting off their blood supply.
The procedure involves the surgeon passing a catheter through the large artery in the thigh and guiding it into the uterine arteries where the blood vessel is injected with microspheres made of plastic.
- Focused ultrasound ablation: This is a procedure similar to that of uterine artery embolization where bleeding caused by fibroids is treated by shrinking the fibroids. Ultrasound sound waves are used in this treatment method to destroy the fibroid tissue.
- Myomectomy: This is a surgical procedure which involves the removal of uterine fibroids. The surgeon may choose to perform the myomectomy using open abdominal surgery depending on the size, number and location of the fibroids. This is performed laparoscopically or through the vagina and cervix (hysteroscopically).
- Endometrial ablation: The lining of the uterus is permanently destroyed through the use of a variety of techniques. Most women have lighter periods after the procedure but pregnancy after could risk the health of the woman. Permanent contraception is highly recommended until menopause.
- Endometrial resection: This surgical procedure involves the removal of the lining of the uterus using an electrosurgical wire loop. This process is beneficial to women experiencing very heavy bleeding and is not recommended for women who want to get pregnant as it could pose health complications.
- Hysterectomy: This is surgery carried out to remove the uterus and cervix. It is a permanent procedure that causes sterility and ends menstrual periods. Additional removal of the ovaries may lead to premature menopause.
All the surgical procedures are usually carried out on an outpatient basis except the hysterectomy process.
DIAGNOSING MENORRHAGIA (HEAVY MENSTRUATIONS)
- Medical history and physical exam: The doctor asks questions about medical history and menstrual cycles to diagnose the problem. Taking records of bleeding and non-bleeding days may be asked including notes on how heavy the flow was and how much sanitary protection may have been used in controlling it.
- Blood tests: A blood sample is taken to test for iron deficiency and other conditions such as thyroid disorders and blood clotting abnormalities.
- Pap test: Here, cells from the cervix are retrieved and tested for infection, inflammation or changes that may be cancerous.
- Endometrial biopsy: Tissue samples from the inside of the uterus are extracted to be examined by a pathologist.
- Ultrasound: This is an imaging method which makes use of sound waves to produce images of the uterus, ovaries and pelvis. Further testing depends on the results gotten from the ultrasound.
- Sonohysterogram: This procedure involves the use of ultrasound to look for problems in the lining of the uterus after the injection of a fluid through a tube into the uterus by way of the vagina and cervix.
- Hysteroscopy: In this procedure, a tiny camera is inserted into the uterus through the vagina and cervix for viewing of the uterus.