Hypermenorrhoea: Causes, Symptoms & Treatment
Hypermenorrhoea refers to abnormally heavy menstrual bleeding. It can have various causes and should always be evaluated by a medical professional.
Things worth knowing about "Hypermenorrhoea"
Hypermenorrhoea refers to abnormally heavy menstrual bleeding. It can have various causes and should always be evaluated by a medical professional.
What is Hypermenorrhoea?
Hypermenorrhoea (also spelled hypermenorrhea) describes menstrual bleeding that is significantly heavier than normal. Clinically, it is defined as a blood loss of more than 80 millilitres per menstrual cycle or a bleeding duration exceeding seven days. Women affected often need to change sanitary products very frequently and may experience exhaustion, weakness, and dizziness due to blood loss.
Causes
Hypermenorrhoea can result from a variety of organic or hormonal conditions, including:
- Uterine fibroids (myomas): Benign muscle tumours of the uterus that can intensify menstrual bleeding.
- Endometriosis: The presence of uterine lining tissue outside the uterus, which can cause heavy bleeding.
- Uterine polyps: Benign growths of the uterine lining or cervix.
- Hormonal imbalances: Disruptions in oestrogen and progesterone levels, for example due to thyroid disorders or polycystic ovary syndrome (PCOS).
- Bleeding disorders: Conditions such as Von Willebrand disease can lead to excessive menstrual blood loss.
- Copper intrauterine device (IUD): Copper coils used for contraception can increase the intensity of menstrual bleeding.
- Uterine cancer: In rare cases, malignant tumours may be the underlying cause.
Symptoms
In addition to excessively heavy bleeding, the following symptoms may occur:
- Severe lower abdominal pain or menstrual cramps (dysmenorrhoea)
- Passage of large blood clots during menstruation
- Fatigue, dizziness, and pallor due to iron-deficiency anaemia
- General weakness and reduced capacity for daily activities
- Need to change sanitary products every hour or more frequently
Diagnosis
The diagnosis of hypermenorrhoea involves a detailed medical history and several examinations:
- Gynaecological examination: Physical examination of the uterus and ovaries.
- Ultrasound (sonography): Imaging of the uterus and ovaries to detect fibroids, polyps, or cysts.
- Blood tests: Measurement of haemoglobin levels, coagulation parameters, and hormonal status (e.g. thyroid function, FSH, LH).
- Hysteroscopy: Direct visual examination of the inside of the uterus using a thin camera.
- Biopsy: Tissue sampling to rule out malignant changes in the uterine lining.
Treatment
Treatment depends on the underlying cause of the hypermenorrhoea:
Medical Treatment
- Hormonal contraceptives: Combined oral contraceptive pills or hormonal intrauterine systems can significantly reduce bleeding intensity.
- Progestogens: Progesterone-based medications can regulate the build-up of the uterine lining.
- GnRH analogues: Used to temporarily suppress hormone production, for example in preparation for surgery.
- Antifibrinolytics: Medications such as tranexamic acid reduce bleeding by inhibiting the breakdown of blood clots.
- Iron supplementation: Used to treat iron-deficiency anaemia resulting from chronic heavy blood loss.
Surgical Treatment
- Hysteroscopic resection: Removal of polyps or fibroids via hysteroscopy.
- Endometrial ablation: Destruction of the uterine lining to permanently reduce bleeding.
- Myomectomy: Surgical removal of fibroids while preserving the uterus.
- Hysterectomy: Surgical removal of the uterus, considered as a last resort in severe cases or when no further pregnancies are desired.
When to See a Doctor
Women who regularly experience very heavy menstrual bleeding should seek medical evaluation. This is especially important if symptoms of anaemia are present, such as pronounced fatigue, dizziness, or pallor. Early diagnosis and treatment can significantly improve quality of life.
References
- Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) - Guideline on Uterine Bleeding Disorders (2022)
- World Health Organization (WHO) - Menstrual health and hygiene (2023), available at: https://www.who.int
- Munro M.G. et al. - FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age, International Journal of Gynecology & Obstetrics, 2011
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