What is Menorrhagia?

About one in four women suffer from menorrhagia, or excessive menstrual bleeding. The condition can be very frustrating and lead to embarrassing situations. As a result, menorrhagia can affect a woman’s lifestyle, causing her to avoid being out in public during menstruation, which affects both her work and personal life. The condition can cause anxiety, lack of confidence, and undue stress.

Menorrhagia also results in physical symptoms, such as severe cramping, over-fatigue and anemia from the amount of blood loss. Menstrual flow is considered heavy when a woman has to change sanitary pads or tampons almost every hour. In some cases, the heavy flow can go on for as much as four or five days.

Causes
In many cases, menorrhagia is caused by hormonal imbalance between estrogen and progesterone. This imbalance causes the endometrium to accumulate and sheds heavily during menstruation.

Some benign fibroid growths and polyps in the uterus, usually appearing during childbearing years, may also cause prolonged menstrual bleeding. These polyps are often caused by high hormonal levels. In rare cases, ovarian, cervical, or uterine cancer can cause menorrhagia.

A condition called adenomyosis, where the endometrium’s glands become embedded in the uterine muscle, can also cause heavy and painful periods. This condition most often develops in middle-aged women who have had children.

Intrauterine devices or IUDs are also one of the known causes of excessive bleeding. In such cases, removing the IUD and switching to another method of birth control would solve the problem.

Other diseases such as endometriosis, pelvic inflammatory disease, kidney, thyroid, and liver have also been associated with menorrhagia. Finally, some medications such as anticoagulants and anti-inflammatory drugs can also contribute to heavy menstrual bleeding.

Diagnosis
In diagnosing menorrhagia, our physicians typically ask patients for their observations on the length and severity of their periods. We will also perform a blood test to check for anemia and a pap test to check for infection and health of the cervix. Additionally, we may perform ultrasound imaging of the uterus and pelvis or an endometrial biopsy to look for any abnormalities.

Menorrhagia Treatment 
Treatment of menorrhagia depends on the root cause of the condition. If the cause is due to hormonal imbalance, drug therapy is often successful in treating menorrhagia. The patient is prescribed iron supplements, non-steroidal anti-inflammatory drugs, such as naproxen, and oral contraceptives to promote balanced estrogen and progesterone levels. One possible contraceptive method that can be prescribed is a hormonal IUD, which releases levonorgestrel, a progestin to help thin the uterine lining and decrease menstrual flow and cramps.

Where drug therapy is unsuccessful or leads to unacceptable side effects, more invasive methods may be required. Dilation and curettage (D&C) is one surgical method of treating menorrhagia. In this procedure, the cervix is dilated, and the uterine lining is thinned by physically scraping or suction of the tissue.

Endometrial ablation procedure is another minimally invasive method that removes the endometrium, ending your periods altogether. This method applies extreme heat to eliminate the uterine lining. The use of heat is accomplished by application of a heated ball or wire loop inserted through the cervix after dilation. Other methods of endometrial ablation procedure use probes that emit microwave or radio frequency energy to heat the endometrial tissue.

Other methods of endometrial ablation utilize either free-flowing heated saline water or a balloon filled with heated fluid to treat virtually the entire endometrium. During the above procedures the woman will be given either partial or general anesthesia.

Endometrial ablation procedure is performed on an outpatient basis and often takes only 15 minutes. It is effective in up to 90% of patients, and patients avoid side effects that result from hormone therapy.
In recovering from an endometrial ablation procedure, women may experience some cramping, which should go away within a few hours. Pain medication is prescribed to deal with cramping or other discomfort. Pink or yellowish discharge may be expelled for a few weeks after treatment. Pelvic pain and fever beyond the first 24 hours are rare and may indicate an infection requiring further medical treatment.

Most women can resume normal activity as early as the next day. The patient is advised not to use tampons and to suspend any sexual activity for up to a week to reduce chances of infection.

In extreme cases of menorrhagia, where both drug and less invasive surgical methods have failed, hysterectomy may be required, which removes the entire uterus and cervix. This is performed under general anesthesia and requires a hospital stay for the patient.

Risks and Complications
Drug therapy is only effective in treating about half of menorrhagia cases. However, it can lead to side effects, such as headaches, nausea, and weight gain. It may also affect cardiovascular health and is contraindicated in those with diabetes or history of heart disease. In addition, menstrual periods may be altered with oral contraceptives.

Endometrial ablation procedures are extremely successful in treating the condition but are only an option once a woman is done with child bearing. Women who may want to have children in the future should avoid this procedure.

Hysterectomy results in permanent infertility because the entire womb and other reproductive parts are removed. The procedure also results in premature menopause for women. This should be considered only if other methods have failed to treat menorrhagia.