This article will outline the causes, symptoms, diagnosis and treatment for Menorrhagia.
In some cases, the cause of severe menstrual bleeding is unknown, but there are a number of conditions that can cause menorrhagia.
During a normal menstrual cycle, the balance of hormones (estrogen and progesterone) regulates the build-up of the endometrium, which forms during menstruation.
When a hormone imbalance occurs, the uterine mucosa develops in excess and spills out to the point of severe menstrual bleeding.
If the ovaries do not release an egg during a menstrual cycle (anovulation), the body does not produce the progesterone hormone as it would during a normal menstrual cycle. This can lead to a hormonal imbalance that can lead to menorrhagia.
Menorrhagia is a known side effect of the use of non-hormonal intrauterine devices for birth control. Polyps are small, benign growths on the lining of the uterus, and uterine polyps can cause severe, long-lasting menstrual bleeding.
Uterine fibroids can cause normal or long-lasting menstrual bleeding. Adenomyosis is a disease that occurs when glands in the lining of the uterus become embedded in the uterine muscles, causing severe bleeding and painful periods.
Non-cancerous, benign tumours of the uterus can occur during childbearing years.
A doctor can help the patient plan alternative management options. A single severe or late period can be due to a miscarriage. The causes of severe bleeding during pregnancy include unusual locations in the placenta, such as when lying on the placenta or when it has previa.
Certain drugs, including anti-inflammatory drugs, hormonal medications such as estrogen and progestin and anticoagulants such as warfarin (Coumadin, Jantoven, Enoxaparin, Lovenox) can also contribute to the strong and long-lasting menstrual bleeding.
Cervical cancer and cervical cancer can also cause excessive menstrual bleeding, particularly if the patient is post-menopausal or have had abnormal Pap tests in the past.
Bleeding disorders, such as von Willebrand’s disease, are conditions in which important clotting factors are deficient or impaired, which can also lead to abnormal menstrual bleeding. A number of other diseases, including liver and kidney disease, have been linked to menorrhagia.
Symptoms of menorrhagia include:
- the soaking of 1 or more tampons or tampons per hour for many consecutive hours
- doubled or changing pads or tampons every night
- period of menstruation lasting for more than 7 days
- bleeding that stops the patient from normal activities
- constant pain in the lower part of the stomach
- lack of energy
- shortness of breath
If the patient changes their pads and tampons 1 or 2 hours after soaking or bleeding for 7 days or more, they should see a doctor immediately.
Symptoms of menorrhagia can look like other illnesses or medical problems. Bleeding excessively during a period can be a sign of a problem. the patient should ask a doctor for a diagnosis.
Women with menorrhagia who bleed for more than 7 days lose too much blood. Menstrual bleeding usually lasts 4 to 5 days, and blood loss can be as little as 2 to 3 tablespoons.
It is not easy to find a woman with severe menstrual bleeding, and every person thinks differently about heavy bleeding.
The patient will have to see a doctor about the patient’s medical history and menstrual cycle to find out if they have Menorrhagia. If the patient wants to track their periods, they can write down the date their period was heavy, how long they think their flow was, and count how many pads and tampons they have used.
This will help the doctor as the patient can give him as much information as possible. If the patient’s bleeding lasts longer than 7 days or their periods are so severe that they need to change pads or tampons every hour, they may need to talk to their doctor.
A doctor will perform a pelvic exam to inform the patient about other tests that can be performed to find out if they have menorrhagia. Blood tests is taken with a needle. It is tested to check for anemia, thyroid problems and problems with the way blood clots clot.
A Pap test is a test in which cells are removed from the cervix to check if the patient has an infection, inflammation, changes in the cells, cancer or something which could cause cancer.
An endometrial biopsy is a test that takes tissue samples from inside the uterus or endometrium to determine if they have cancer or other abnormal cells.
An ultrasound test is a painless test that uses sound waves and a computer to show what the blood vessels, tissues and organs look like.
A doctor can see how they work and control the blood flow. It does not take long for the pain to disappear after the test. If the patient feels that they have bad menstrual cramps, the test should be done immediately.
The treatment options offered to the patient for Menorrhagia will depend on the symptoms, general health, the cause of the difficult periods, whether they want to have a baby or intend to become pregnant in the future, and their personal preferences.
The patient should discuss the benefits and risks of the various options with a doctor, including the effects on future fertility treatments.
The intrauterine system (IUS) is a small plastic device that is inserted into the uterus by a doctor or nurse. It prevents the endometrium from growing like a contraceptive. It also releases hormones called progestin.
The IUS is the preferred initial treatment for women with severe menstrual bleeding, but it can take up to 6 periods for the patient to see the benefits.
If they are prescribed tranexamic acid tablets, the IUS may be inappropriate and may have to wait for further tests and treatments. The IUS does not affect the patient’s chances of getting pregnant if they stop using it.
Possible side effects of IU include irregular bleeding lasting longer than 6 months, breast sensitivity, acne and stopped or missed periods.
Tranexamic acid tablets are taken 3 times a day for a maximum of 4 days. The tablets work by causing blood to clot in the womb. They are not a form of contraception and do not affect the chances of getting pregnant. The patient starts taking the tablets before their period begins.
If necessary, tranexamic acid can be combined with non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs can be used to treat severe IUS, but may not be suitable if they are waiting for further tests or other treatments.
They can be taken in tablet form at the beginning of the period or after the heavy bleeding has stopped. They are also available without a prescription.
These NSAIDs work by reducing the body’s production of a hormone-like substance called prostaglandins that is associated with frequent periods.
The patient can take them for as long as they need, and they make the bleeding less severe and cause no significant side effects. They can also help relieve pain in the period. However, they are not a form of contraception.
The patient should just make sure that they do not take more than the recommended daily dose indicated on the pack (e.g. Daily or weekly).
Advantages of using combined oral contraceptives as a treatment for severe phases provide a reversible form of contraception for IUS. They can be used to treat severe phases.
Combined oral contraceptives can also have the advantage of regulating the menstrual cycle and reducing pain during the period. Combined birth control pills contain the hormones estrogen and progestin.
If the patient takes the pill, it can prevent pregnancy. The pill works by preventing the ovaries from releasing an egg every month.
Common side effects of the combined oral birth control pill include mood swings, nausea, headaches and breast sensitivity. If other treatments do not help, the patient may be offered a type of drug called cyclic progestin.
It is taken as a tablet and is part of the menstrual cycle. It is not the most effective form of contraception and may have unpleasant side effects, including breast sensitivity and bleeding during the period. A doctor may advise the patient to take only cyclic progestin.
In endometrial ablation, the endometrial lining (endometrium) is thinned, removed or destroyed. Depending on how much of the uterine lining is left, it can brighten or stop the period.
Endometrial ablation uses various techniques, including: it can use heat from an electrical source, radio waves or lasers that can be used to destroy the endometrium, vagina or cervix.
Endometrial ablation can also use ultrasound energy, and a high level of ultrasound energy can be used in the body to destroy fibroids that can damage the healthy lining of the uterus.
After the ablation of the uterine mucosa, vaginal bleeding or light phases may occur for a few days. The procedures are usually fast and the patient can go home the same day. The procedure is performed under local anaesthetic or general anaesthetic.
First use a hygiene wipe instead of a tampon or tampon and then gradually more often and more effectively.
Some women report severe and persistent pain after endometrial ablation. In these cases, the patient should talk to their GP or a member of the hospital team who may be able to prescribe stronger painkillers.
Abdominal cramps or period pain can also occur on the second day after the procedure. These can be treated with painkillers such as paracetamol or ibuprofen. Some women have a bloody discharge after 3-4 weeks.
It is unlikely that the patient will become pregnant after endometrial ablation. If they do, they may have an increased risk of miscarriage or other complications.