Menorrhagia (aka hematomunia) is abnormally heavy and prolonged menstrual period [at regular intervals].
Patient information
What is menorrhagia? I'm guessing it's related to menstruation?
That's correct. The ending "rrhage" means excessive flow, like as in "hemorrhage" which means "bleeding". So it's excessive period bleeding.
What do you mean excessive? Like a lot of bleeding?
Yeah, so it's the amount, or length of bleeding.
Sx
Depending on cause, it may be associated with dysmenorrhea (painful periods)
Eventually, Sx of anemia (SOB, tiredness, weakness, tingling/numbness in extremities, headaches, depression, becoming cold more easily, poor concentration)
Causes
Abnormalities with blood clotting, including: → required to stop blood flow, following shedding of endometrial lining's blood vessels
Bleeding disorders (e.g. von Willebrand)
Anticoagulants (e.g. warfarin)
Disruption of normal hormonal regulation of periods
Excessive build up in endometrial lining [of the uterus], including:
Physiologically, just after the onset of menstruation (menarche), and just before menopause
PID → painful → irritation of the endometrium
IUD → irritation of the endometrium
Uterine fibroids → painless → can increase the endometrium's surface area
Patient information
What causes excessive or prolonged menstrual bleeding?
So it can be due to problems with blood clotting, like bleeding disorders or use of drugs that prevent blood clotting. The normal hormonal regulation of periods can be disrupted. And there can be excessive build up of the inner lining of the womb, which is more common just after you get your periods, or just before menopause; also, PID or IUD's which irritates the lining; and fibroids in the womb, which increases it's surface area.
Ix
Pelvic and rectal exam → locate source of bleeding
Reassurance, if the degree of bleeding is mild, and there is no sinister underlying cause. Clear heavy periods at menarche (start of periods) and menopause (cessation of periods) may settle spontaneously
Drugs, including:
Iron tablets, if there is iron deficient anemia
Pills (COCP, progesterone-only pills), to prevent proliferation of the endometrium; and for DUB, which commonly occurs at menarche and menopause, when contraception will also be sought anyway
IUD w/ progesterone
Tranexamic acid (i.e. antifibrinolytic), may reduce loss by 50%, and can be combined with hormonal medication
Anti-inflammatories (e.g. NSAID's), first line in ovulatory menorrhagia, resulting in reduction of 33% in menstrual blood flow
Surgery, including:
Myomectomy, to remove small fibroids
Endometrial ablation, where the inner lining of the womb is vaporized, chipped, or otherwise destroyed
Uterine artery embolisation (UAE), which is using a catheter to deliver small particles that block the blood supply to the womb
Hysterectomy (remove uterus), to remove fibroids >3cm, and/or if other options have been exhausted
Patient information
How can you fix more or longer menstrual bleeding?
If there's an underlying cause, you can treat that. Usually, there's no need to do anything. If there is iron deficiency, you can give iron. Hormone, given through oral contraceptive pills or IUD can prevent the womb's inner lining from proliferating. Tranexamic acid is a drug that inhibits the breakdown of fibrin in blood clots, so it helps to maintain clots. It can also be painful, so we can give NSAID's.
What about if none of that works, and there's still more or longer menstrual bleeding?
We can try surgery. So we can remove fibroids, if that's the cause. We can destroy the inner lining of the womb. We can block the blood supply to the womb. We can also remove the womb itself.
Complications
Social stress of dealing w/ prolonged and heavy period
Anemia, due to chronic blood loss depletes body iron reserves
Epidemiology
The use of hysterectomy for menorrhagia has almost halved in the last 20 years
Medicinenet.com Word of the Day Medicinenet.com Daily News
Medpage Today Latest Medical News
Health.com Happy & Healthy
Medical News Today headlines
Internal Medicine Clinical News
Modern Medicine News Modern Medicine Feature articles
Cleveland Clinic Journal of Medicine
BMJ Latest news BMJ Latest research BMJ Education
JAMA Current issue
The Lancet Current issue
NEJM Current issue
ScienceMag Current issue
NIH PubMed Health Featured reviews
ABC Health news ABC Health & Wellbeing ABC Health Minutes ABC RN's The Health Report ABC All in The Mind
BBC News - Health (International)
NSW Health Minister for Health Minister for Mental Health NSW Health Publications AI of Health & Welfare Publications Department of Health Publications
WHO Health news WHO Emergencies, disasters news WHO Disease Outbreaks WHO Health feature stories