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Menorrhagia – Causes, Symptoms and Treatment

Menorrhagia refers to abnormally heavy or prolonged menstrual bleeding. It can significantly impact quality of life and may indicate an underlying gynecological condition.

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Things worth knowing about "Menorrhagia"

Menorrhagia refers to abnormally heavy or prolonged menstrual bleeding. It can significantly impact quality of life and may indicate an underlying gynecological condition.

What is Menorrhagia?

Menorrhagia is the medical term for unusually heavy or prolonged menstrual bleeding. It is generally defined as a blood loss of more than 80 milliliters per cycle or menstrual bleeding lasting longer than 7 days. Women affected by menorrhagia often need to change sanitary products every hour and may find their daily activities severely disrupted. It is one of the most common gynecological complaints, affecting women of all reproductive ages, with higher prevalence during the perimenopause.

Causes

Menorrhagia can result from a variety of hormonal, structural, and systemic causes:

Hormonal imbalances: An imbalance between estrogen and progesterone can lead to excessive thickening of the uterine lining (endometrium), resulting in heavier bleeding.
Uterine fibroids: Benign muscle tumors in the uterus frequently associated with heavy menstrual bleeding.
Endometriosis: A condition in which tissue similar to the uterine lining grows outside the uterus.
Endometrial polyps: Benign growths of the uterine lining that can cause irregular or heavy bleeding.
Adenomyosis: A condition in which the uterine lining grows into the muscular wall of the uterus.
Bleeding disorders: Conditions such as von Willebrand disease can impair normal blood clotting and cause heavy periods.
Intrauterine devices (IUDs): Copper-based IUDs are a known cause of increased menstrual blood loss.
Thyroid disorders: Hypothyroidism in particular can disrupt the menstrual cycle and lead to heavier bleeding.

Symptoms

Common symptoms of menorrhagia include:

Menstrual bleeding lasting more than 7 days
Need to change sanitary products every hour or more frequently
Passing blood clots larger than 2.5 cm in diameter
Bleeding that disrupts sleep
Symptoms of anemia such as fatigue, pallor, dizziness, and shortness of breath
Pelvic pain and cramping

Diagnosis

The diagnosis of menorrhagia is based on the medical history, physical examination, and targeted diagnostic tests:

Medical history and menstrual diary: Recording the duration, heaviness, and associated symptoms of each cycle.
Gynecological examination: Assessment of the uterus and ovaries.
Ultrasound (sonography): Imaging to detect structural abnormalities such as fibroids or polyps.
Blood tests: Full blood count to check for anemia, hormone levels, and coagulation profile.
Hysteroscopy: Direct visualization of the uterine cavity using a thin camera-equipped instrument.
Endometrial biopsy: Tissue sampling from the uterine lining to rule out malignant changes.

Treatment

Treatment of menorrhagia depends on the underlying cause, the severity of symptoms, and whether the patient wishes to preserve fertility:

Medical Treatment

Hormonal contraceptives: Combined oral contraceptive pills or the hormonal intrauterine system (levonorgestrel-IUS) can significantly reduce menstrual blood loss.
Progestogens: Progesterone-based medications help regulate the growth of the uterine lining.
Tranexamic acid: An antifibrinolytic agent that supports blood clotting and reduces blood loss during menstruation.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen or naproxen can reduce both blood loss and menstrual pain.

Surgical Treatment

Endometrial ablation: Destruction of the uterine lining using heat, cold, or laser energy to reduce or stop menstrual bleeding.
Myomectomy: Surgical removal of uterine fibroids while preserving the uterus.
Hysterectomy: Surgical removal of the uterus, considered as a last resort for women with treatment-resistant menorrhagia who do not wish to have children.

When to See a Doctor

Women should seek medical advice if their periods are consistently very heavy, last longer than 7 days, involve the passage of large blood clots, or if they experience persistent symptoms of anemia such as fatigue, dizziness, or shortness of breath. Early diagnosis and treatment are essential to prevent complications such as iron deficiency anemia.

References

Munro MG et al. - FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. International Journal of Gynecology and Obstetrics, 2011.
National Institute for Health and Care Excellence (NICE) - Heavy menstrual bleeding: assessment and management. NICE guideline NG88, 2018 (updated 2021).
Wouk N, Helton M. - Abnormal Uterine Bleeding in Premenopausal Women. American Family Physician, 2019.

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