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Menorrhagia

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What Is Menorrhagia? 

Excessive discharge of blood during the monthly periods / menses is known as menorrhagia. Menorrhagia is an abnormally heavy and prolonged menstrual period at regular intervals. It constitutes a significant problem in pre-menopausal women - resulting in adverse health, reduced quality of life and much disruption in the lives of those afflicted. Clinically, menorrhagia is defined as total blood loss exceeding 80 ml per cycle or menses lasting longer than 7 days, saturates tampons or napkins within an hour or includes large clots of blood.

 

Menorrhagia distinguishes from, but may overlap with:

►Metrorrhagia: Irregular Or Frequent Flow, Noncyclic I.E. Bleeding Between The Periods.

►Menometrorrhagia: Frequent, Excessive, Irregular Flow (Menorrhagia Plus Metrorrhagia).

►Polymenorrhea: Frequent Flow, Cycles Of 21 Days Or Less.

►Intermenstrual Bleeding: Bleeding Between Regular Menses.

►Dysfunctional Uterine Bleeding (DUB): Abnormal Endometrial Bleeding Of Hormonal Cause And Related To Anovulation.

The World Health Organization reports that 18 million women aged 30-55 years perceive their menstrual bleeding to be exorbitant. Around 1 in 20 women aged 30-49 will seek advice from their gynecologist to help resolve them.

 

Causes Of Menorrhagia: 

In some cases, the cause of heavy menstrual bleeding is unknown, but a number of conditions may cause menorrhagia. Common causes include:

►Hormonal imbalance: In a normal menstrual cycle, a balance between the hormones estrogen and progesterone regulates the buildup of the lining of the uterus (endometrium), which is shed during menstruation. If a hormonal imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding.

►Dysfunction of the ovaries: If ovulation does not occur in a menstrual cycle (anovulation), progesterone is not produced. This causes hormonal imbalance and may result in menorrhagia.

►Uterine fibroids: These noncancerous (benign) tumors of the uterus appear during your childbearing years. Uterine fibroids may cause heavier than normal or prolonged menstrual bleeding.

►Polyps: Small, benign growths on the lining of the uterine wall (uterine polyps) may cause heavy or prolonged menstrual bleeding. Polyps of the uterus most commonly occur in women of reproductive age as the result of high hormone levels.

Adenomyosis: This condition occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding and painful menses. Adenomyosis is most likely to develop if you're a middle-aged woman who has had children.

►Intrauterine device (IUD): Menorrhagia is a well-known side effect of using a nonhormonal intrauterine device for birth control. When an IUD is the cause of excessive menstrual bleeding, you may need to remove it.

Pregnancy complications: A single, heavy, late period may be due to a miscarriage. If bleeding occurs at the usual time of menstruation, however, miscarriage is unlikely to be the cause. An ectopic pregnancy  mplantation of a fertilized egg within the fallopian tube instead of the uterus also may cause menorrhagia.

Cancer: Rarely, uterine cancer, ovarian cancer and cervical cancer can cause excessive menstrual bleeding.

Inherited bleeding disorders: Some blood coagulation disorders — such as von Willebrand's disease, a condition in which an important blood-clotting factor is deficient or impaired can cause abnormal menstrual bleeding.

Medications: Certain drugs, including anti-inflammatory medications and anticoagulants, can contribute to heavy or prolonged menstrual bleeding. Improper use of hormone medications also can cause menorrhagia.

Other medical conditions: A number of other medical conditions, including pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease, may be associated with menorrhagia.

 

Tests and diagnosis:

Doctor will most likely ask about your medical history and menstrual cycles. You may be asked to keep a diary of bleeding and non-bleeding days, including notes on how heavy your flow was and how much sanitary protection you needed to control it. Your doctor will do a physical exam and may recommend one or more tests or procedures such as:

Blood tests: A sample of your blood is evaluated in case excessive blood loss during menstruation has made you anemic. Tests may also be done to check for thyroid disorders or blood-clotting abnormalities.

Pap test: Your doctor collects cells from your cervix for microscopic examination to detect infection, inflammation or changes that may be cancerous or may lead to cancer.

Endometrial biopsy: Your doctor may take a sample of tissue from the inside of your uterus to be examined under a microscope.

Ultrasound scan: This imaging method uses sound waves to produce images of your uterus, ovaries and pelvis.

 

Based on the results of your initial tests, your doctor may recommend further testing, including:

Sonohysterogram: This ultrasound scan is done after fluid is injected, through a tube, into your uterus by way of your vagina and cervix. This allows your doctor to look for problems in the lining of your uterus.

Hysteroscopy: A tiny tube with a light is inserted through your vagina and cervix into your uterus, which allows your doctor to see the inside of your uterus.

Dilation and curettage (D&C): In this procedure, your doctor opens (dilates) your cervix and then inserts a spoon-shaped instrument (curet) into your uterus to collect tissue from the uterine lining. This tissue is examined in the laboratory.

Doctors can be certain of a diagnosis of menorrhagia only after ruling out other menstrual disorders, medical conditions or medications as possible causes or aggravations of this condition.