Heavy Bleeding

Menorrhagia means exceptionally heavy and prolonged bleeding during menstruation.  Many women go through heavy menstrual bleeding at some points during their lifetime, but this should not be confused with menorrhagia.

Menorrhagia affects day to day activities due to the amount of blood loss and pain.

Causes

Menorrhagia is caused by a variety of conditions and diseases in the pelvic region, however, in some rare cases the cause can remain unknown.  Common causes are,

  • Hormonal Imbalance: This occurs when there is an uneven production of hormones estrogen and progesterone resulting in excess development of endometrium. This excess development of the endometrium results in abnormally heavy bleeding.
  • Dysfunctional Ovaries: When ovaries fail to release the egg during ovulation, production of progesterone decreases resulting in hormonal imbalance. This hormonal imbalance can lead to menorrhagia.
  • Uterine fibroids: These noncancerous (benign) tumors are one of the main culprits resulting in excessive bleeding.
  • Polyps: These are small, benign growths on the tissue lining the uterus.
  • Adenomyosis: Adenomyosis occurs when the tissue lining the uterus grows into the uterine wall causing abnormal bleeding and painful periods.
  • Pregnancy complications: Complications during pregnancy such as a miscarriage or faulty location of placenta can result in menorrhagia.
  • Cancer: Cancer of the uterus and cervix can result in menorrhagia.
  • Inherited bleeding disorders: Certain bleeding disorders like von Willebrand’s disease can be a reason of abnormal menstrual bleeding.
  • Medications: Menorrhagia can also be due to side effects of certain medications.
What are the Symptoms
  • Requirement to change sanitary napkins or tampons every hour for several hours
  • Bleeding lasting for more than a week
  • Passing large amounts of blood clots
  • Restriction in daily activities
  • Experiencing symptoms of anemia like fatigue and shortness of breath
What tests will be required for diagnosis?
  • Physical examination by your doctor
  • Ultrasound scan
  • CT/ MRI scan
  • Pap smear
  • Endometrial biopsy.
What are the treatment options available?

Both, conservative as well as surgical measures are used to treat menorrhagia.  Treatment for menorrhagia depends on overall health and medical history.

  • Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) are the first choice of treatment for menorrhagia.  If NSAIDs fail to reduce bleeding, then other drugs are prescribed, they are Tranexamic acid, birth control pills and oral progesterone.

  • Surgical Procedures

There are a number of surgical procedures to tackle menorrhagia.

  1. Dilation and curettage (D&C): In this procedure, tissue lining the uterus is suctioned or scrapped out.
  2. Uterine artery embolization: This procedure is done to shrink the fibroids by cutting off blood supply to the uterine arteries.
  3. Focused ultrasound surgery: This procedure is also done to shrink the fibroid using ultrasound waves.
  4. Myomectomy: This procedure is done to surgically remove the uterine fibroids. Myomectomy can either be done through an abdominal incision or through the vagina depending on the size of the fibroid.
  5. Endometrial ablation: This procedure is done to destroy the tissue lining the uterus (endometrium). Laser or radiofrequency is used to destroy the lining.
  6. Endometrial resection: This procedure is done to remove the uterine lining by using electrosurgical wire loop. Pregnancy should be avoided after this procedure.
  7. Hysterectomy: This procedure involves removal of the uterus and cervix in their entirety.  This procedure is done as a last resort when all other measures to stop blood loss have failed.  This procedure is only done when the woman no longer wishes to bear a child.