Menorrhagia (Heavy Menstrual Bleeding)

Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding. While heavy menstrual bleeding is a common concern, menorrhagia is characterized by bleeding that is so heavy it interferes with a woman's physical, social, emotional, and material quality of life. It may be defined as bleeding that lasts more than 7 days, requires changing sanitary products every hour or less, passing large blood clots, or needing to use double sanitary protection. Menorrhagia can lead to anemia, causing fatigue and weakness, and may signal underlying health conditions that require treatment. With proper diagnosis and management, most women with menorrhagia can find relief and improved quality of life.

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What Causes It?

Hormonal imbalances - Fluctuations in estrogen and progesterone levels can lead to excessive endometrial growth and heavy shedding.

Uterine fibroids - Noncancerous growths in the uterus that can cause heavier or longer menstrual periods.

Polyps - Small, benign growths on the lining of the uterine cavity or cervical canal.

Adenomyosis - When endometrial tissue grows into the muscular walls of the uterus.

Endometriosis - Condition where endometrial tissue grows outside the uterus.

Intrauterine device (IUD) - Non-hormonal copper IUDs can increase menstrual bleeding, especially initially.

Complications of pregnancy - Such as miscarriage or ectopic pregnancy.

Cancer - Uterine, ovarian, or cervical cancer, though these are less common causes.

Inherited bleeding disorders - Such as von Willebrand disease or platelet function disorders.

Medications - Anticoagulants, anti-inflammatory drugs, hormonal medications, or copper IUDs.

Thyroid problems - Both hypothyroidism and hyperthyroidism can affect menstrual flow.

Liver or kidney disease - Can affect hormonal metabolism and clotting factor production.

Pelvic inflammatory disease (PID) - Infection of the female reproductive organs.

Obesity - Excess weight can lead to hormonal imbalances that affect menstrual flow.

Stress - High stress levels can disrupt normal hormonal balance.

Perimenopause - The transition years before menopause often involve irregular or heavy periods.

Signs & Symptoms

Menstrual flow that soaks through one or more sanitary pads or tampons every hour for several consecutive hours.

Need to use double sanitary protection to control menstrual flow.

Need to change sanitary protection during the night.

Menstrual periods lasting longer than 7 days.

Passing blood clots larger than a quarter.

Restricting daily activities due to heavy menstrual flow.

Symptoms of anemia, such as tiredness, fatigue, or shortness of breath.

Constant pain in the lower abdomen during menstrual periods.

Irregular menstrual periods.

Bleeding between periods or spotting.

Feeling of fullness or pressure in the pelvic area.

Flooding or gushing sensation during menstrual flow.

How We Diagnose

Our specialists use advanced diagnostic methods to accurately identify and assess your condition

Medical History and Physical Examination

Your doctor will ask detailed questions about your menstrual history, symptoms, overall health, and family medical history. A pelvic examination will be performed to check for any obvious physical abnormalities or signs of infection.

Blood Tests

These may include a complete blood count to check for anemia, iron levels, thyroid function tests, clotting factor tests if a bleeding disorder is suspected, and hormone levels to check for conditions like polycystic ovary syndrome or thyroid disorders.

Pap Test

A screening test for cervical cancer and certain infections that might contribute to abnormal bleeding.

Endometrial Biopsy

A small sample of tissue from the lining of the uterus (endometrium) is removed and examined under a microscope to check for abnormal cells or cancer.

Ultrasound

Uses sound waves to produce images of the uterus, ovaries, and pelvis. Transvaginal ultrasound, where the ultrasound wand is inserted into the vagina, provides more detailed images of the uterine lining and can detect fibroids, polyps, or other structural abnormalities.

Sonohysterography

A specialized ultrasound where fluid is injected into the uterus before the ultrasound to provide better visualization of the uterine cavity and any growths or abnormalities.

Hysteroscopy

A thin, lighted scope is inserted through the vagina and cervix into the uterus, allowing the doctor to see inside the uterine cavity and identify any abnormalities. Tissue samples can be taken during this procedure.

MRI

Provides detailed images of the uterus and other pelvic organs, useful for evaluating the extent of conditions like adenomyosis or fibroids.

Treatment Options

Personalized treatment plans tailored to your specific needs and condition

Medications

Various medications can help reduce menstrual bleeding and regulate the menstrual cycle, including nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, tranexamic acid, oral contraceptives (birth control pills), progesterone, hormonal IUDs, and gonadotropin-releasing hormone agonists.

Iron Supplements

If menorrhagia has caused iron deficiency anemia, iron supplements can help restore iron levels and alleviate symptoms like fatigue and weakness.

Endometrial Ablation

A procedure that destroys or removes the endometrium (the lining of the uterus) using heat, cold, microwave energy, or other methods. This reduces or stops menstrual flow and can be performed as an outpatient procedure.

Uterine Artery Embolization

A minimally invasive procedure that blocks the blood vessels supplying the uterus, causing fibroids to shrink. This can significantly reduce menstrual bleeding in women whose heavy periods are caused by fibroids.

Myomectomy

Surgical removal of uterine fibroids while leaving the uterus intact. This procedure is an option for women who want to preserve their fertility.

Hysterectomy

Surgical removal of the uterus, which permanently stops menstrual periods. This is a definitive treatment for menorrhagia but ends the ability to become pregnant and is typically considered only when other treatments have failed or aren't appropriate.

Dilation and Curettage (D&C)

A procedure where the cervix is dilated and a special instrument is used to scrape the uterine lining. D&C can provide temporary relief from heavy bleeding but is not a long-term solution for most cases of menorrhagia.

Home Remedies

Iron-Rich Diet

Consume iron-rich foods like lean red meat, poultry, seafood, beans, dark leafy greens, and iron-fortified cereals to help prevent or treat iron-deficiency anemia caused by heavy bleeding. Vitamin C enhances iron absorption, so include citrus fruits, berries, or bell peppers with iron-rich meals.

Heat Therapy

Applying a heating pad or hot water bottle to the lower abdomen can help relax the uterine muscles and reduce cramping and pain associated with heavy periods. Use for 15-20 minutes at a time, several times a day as needed.

Herbal Teas

Some herbal teas like ginger, cinnamon, or raspberry leaf tea may help reduce menstrual flow and alleviate cramps, though scientific evidence is limited. Consult with your healthcare provider before using herbal remedies, especially if you take medications.

Over-the-Counter Pain Relievers

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen not only relieve pain but can also reduce menstrual flow by up to 20-50%. Take as directed starting a day or two before your period begins and continue through the heaviest days of bleeding.

Stress Reduction

Practice stress-management techniques such as deep breathing, meditation, yoga, or progressive muscle relaxation, as stress can worsen menstrual symptoms and potentially affect hormone balance.

Regular Exercise

Moderate physical activity can help regulate hormones and reduce menstrual symptoms. Aim for at least 30 minutes of activity most days, but consider reducing intensity during the heaviest days of your period and focus on gentle exercises like walking, swimming, or yoga.

Adequate Rest

Prioritize getting 7-9 hours of quality sleep each night, especially during your period when your body may need extra rest to combat fatigue from blood loss. Consider napping if needed and possible.

Track Your Menstrual Cycle

Keep a detailed record of your menstrual cycle, including the duration, heaviness of flow, and any symptoms. This information can help you prepare for heavy days and provide valuable information for your healthcare provider.

Prevention Tips

Attend regular gynecological check-ups to monitor your reproductive health.

Report any changes in your menstrual pattern to your healthcare provider promptly.

Take medications as prescribed, especially hormonal treatments for menorrhagia.

Maintain a healthy weight through balanced nutrition and regular physical activity.

Manage stress through relaxation techniques and adequate rest.

If you have an underlying condition contributing to menorrhagia (like thyroid disorder), ensure it's properly treated and monitored.

Follow up with recommended tests and procedures to monitor treatment effectiveness.

Get tested for bleeding disorders if you have a family history or symptoms suggest this possibility.

If using a hormonal IUD or birth control pills for menorrhagia, attend follow-up appointments to ensure they're working effectively.

Consider keeping a menstrual calendar to track improvements or changes in bleeding patterns with treatment.

Monitor for signs of anemia and report symptoms like extreme fatigue, weakness, or shortness of breath.

Keep iron levels healthy through diet or supplements as recommended by your doctor.

If planning pregnancy, discuss your menorrhagia and its treatment with your healthcare provider beforehand.

Surgical Solutions

Advanced surgical procedures performed by our expert specialists

Endometrial Ablation

A minimally invasive procedure that destroys the lining of the uterus (endometrium) using heat, cold, microwave energy, or electrical energy. Various techniques include radiofrequency ablation, balloon thermal ablation, microwave ablation, and cryoablation. This procedure significantly reduces or stops menstrual bleeding in most women while preserving the uterus, though it is not recommended for women who wish to become pregnant in the future.

Hysteroscopic Myomectomy

A procedure to remove submucosal fibroids (those that grow into the uterine cavity) using a resectoscope inserted through the vagina and cervix. This minimally invasive approach can effectively treat fibroids that contribute to heavy bleeding while preserving fertility, though it's limited to certain types and sizes of fibroids.

Hysterectomy

Surgical removal of the uterus, which permanently stops menstrual bleeding. This may be performed abdominally, vaginally, or laparoscopically, with various degrees of ovary and fallopian tube removal depending on the patient's needs. While effective, this major surgery ends fertility and requires significant recovery time. It's typically considered only when other treatments have failed or aren't appropriate.

Uterine Artery Embolization (UAE)

A minimally invasive procedure performed by an interventional radiologist that blocks the blood vessels supplying the uterus. Small particles are injected through a catheter into the uterine arteries, causing fibroids to shrink and reducing menstrual bleeding. This procedure preserves the uterus and requires shorter recovery than major surgery, though its effects on fertility remain under study.

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