Heavy Bleeding or Menorrhagia

About Menorrhagia

Menorrhagia is characterised by abnormally heavy, prolonged bleeding or both during menstruation. Women with menorrhagia may have substantial blood loss of about 80cc or more during periods and pain that disturbs normal activities.

Symptoms of Menorrhagia

Common Symptoms of Menorrhagia are:

• Heavy menstrual flow that needs changing of sanitary pad every hour for several consecutive hours
• Periods lasting for more than seven days
• Passage of large blood clots
• Need to use both tampons and sanitary pads together
• Staining clothes or bed linen
• Fatigue, weakness or shortness of breath

Causes of 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 tumours of the uterus),
• uterine polyps,
• adenomyosis (where endometrial glands are found in the muscular wall of the uterus),
• use of 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 and liver or kidney disease.

Your doctor will perform a pelvic examination and may recommend other tests or procedures such as a pelvic ultrasound scan or a biopsy of the womb's lining.

A biopsy is a technique of removing a piece of tissue from the inner lining of the uterus and is examined under a microscope. Your doctor may also recommend an examination called hysteroscopy, which involves placing a tiny tube with a light through your cervix to obtain a direct view of the lining of the womb.

Menorrhagia Treatment

Menorrhagia Treatment options will depend on the cause and severity of menorrhagia and also on your overall health. 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 contraceptive pills may be given to help reduce bleeding and regularise your menstrual cycle
• Tranexamic acid which reduces flow by 50%
• Oral progesterone may be given to help correct hormonal imbalance
• Mirena, a type of intrauterine device which releases progestin in the womb that thins the uterine lining and reduces the blood flow, may be used

Surgery for Menorrhagia

Menorrhagia may be needed if conservative treatment is not successful. The surgical procedures include:

• Hysteroscopy: This procedure involves the use of a hysteroscope, a tiny tube with a light to view your uterine cavity and to remove abnormalities such as a polyp which may be the cause of heavy menstrual bleeding
• Dilation and curettage (D&C): It is a procedure in which the cervix is dilated, and the lining of the uterus is scraped to reduce menstrual bleeding and diagnose any abnormalities. You may need additional D&C procedures if menorrhagia recurs
• Endometrial ablation: It is a procedure that permanently destroys the entire lining of your uterus (endometrium), resulting in little or no menstrual flow
• Endometrial resection: It is a surgical procedure that uses an electrosurgical wire loop to remove the lining of the uterus.
• Hysterectomy: It involves surgical removal of the uterus and the cervix that leads to infertility and cessation of menstrual period.