Menorrhagia

Menorrhagia is a condition characterised by abnormally heavy or prolonged menstrual bleeding, which may be disruptive to your normal activities.

The most common symptoms of menorrhagia are:

  • Excessive menstrual flow that requires frequent changes, double sanitary protection, embarrassing accidents
  • Menstrual period that lasts longer than seven days
  • The passage of large blood clots
  • Fatigue, weakness or shortness of breath (symptoms of anaemia secondary to the menorrhagia)

The cause of menorrhagia is not known in some cases; however, several conditions that may cause menorrhagia include hormonal imbalance, dysfunction of the ovaries, uterine fibroids(non-cancerous (benign) tumours of the uterus), uterine polyps, adenomyosis (where endometrial glands are found in the muscular wall of the uterus), intrauterine devices (IUDs), cancer, inherited blood disorders, certain medications (anti-inflammatory medications and anticoagulants), and other medical conditions such as pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease.

Your doctor will do a pelvic examination and may recommend other tests or procedures such as a pelvic ultrasound scan or a biopsy of the lining of the womb if the woman is over 40 years of age. Biopsy is a technique of removing a piece of tissue from the inner lining of the uterus and is examined under a microscope. This is done to make sure that the cells are normal. Your doctor may also recommend an examination called a hysteroscopy, which involves placing a tiny telescope through your cervix to obtain a direct view of the lining of the womb.

Treatment options will depend on the cause of menorrhagia, the severity of menorrhagia and the overall health of the patient. Some common treatments include:

  • Iron supplements may be started if your iron levels are low.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) may help reduce menstrual blood flow as well as cramping.
  • Oral contraceptives may be given to help reduce bleeding and make menstrual cycles more regular.
  • Oral progesterone may be given to help correct hormonal imbalance and reduce menorrhagia.
  • Mirena, a type of intrauterine device which releases progesterone in the womb that thins the uterine lining and reduces the blood flow may be used.

Surgery may be needed if medication therapy is not successful. The surgical procedures include:

  • Endometrial ablation: Is a procedure that permanently destroys the entire lining of your uterus (endometrium) resulting in little or no menstrual flow.
  • Dilation and curettage (D&C): Is a procedure in which the cervix is dilated and the lining of the uterus is scraped to reduce menstrual bleeding. You may need additional D&C procedures if menorrhagia recurs.
  • Hysteroscopy: This procedure involves the use of a telescope to view your uterine cavity and to remove abnormalities, such as a polyp, that may be causing heavy menstrual bleeding.
  • Endometrial Resection: Is a surgical procedure that uses an electrosurgical wire loop to remove the lining of the uterus.
  • Hysterectomy: Is surgical removal of the uterus.

Surgical procedures should generally be deferred until your family is complete. Therefore, discuss with your doctor about the treatment options if you plan to become pregnant in the future.
 
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