Definition of "Menorrhagia"

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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
  • Pelvic U/S → identify structural abnormalities
  • Endometrial biopsy → exclude endometrial cancer/hyperplasia
  • Hysteroscopy → endometrial polyp, uterine fibroid
Tx
  • Tx the underlying cause
  • 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
  • Up to 64% of women will cancel a hysterectomy
See also

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Definition of Menorrhagia | Autoprac


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