Menorrhagia

Definition of Menorrhagia

Menorrhagia is also known as “heavy” or “prolonged” menstrual cycle periods. This is only noted among women since they undergo the menstrual periods such as menarche (first menses) and menopause (last menses). ^[1]

Risks

This condition is common to the following individuals, who needs to take precautions and extra care when it comes to their health: ^[2]

Girls/Women who had their menarches (first menstrual period)
Pre-menopausal Women (coming to an end of menstrual cycle period)

Symptoms

The following are felt by the patient when suffering from the condition of Menorrhagia:^[2][3]

Heavy to prolonged bleeding during the night.
Moderate to severe bleeding
Prolonged menstrual cycle usually lasting more than seven (7) days
Severe blood loss
Blood clots passing through the vagina
Lower abdominal cramps
Saturated sanitary pads d/t to increased amount and volume of blood
Sleep deprivation during the night because of soaked napkins
Paleness (d/t to loss of blood, possible Anemia can be noted)
Exhaustion and fatigue
Dyspnea (difficulty of breathing)
Abnormal blood volume during menses

Causes

There are possible causes that can be noted when it comes to bleeding specially in the reproductive area, the following are the common causes of menorrhagia: ^[2][3]

Idiopathic (the cause is unkown)
Hormonal imbalance – alteration of the levels of estrogen and progesterone. These is usually noted when the women is also nearing to menopausal stage. Thus, Dysfunction of the ovaries (an alteration with the normal function in the ovaries) occurs.
Cancer – uterine cancer is seldom noted but other forms of cancer such as ovaries and cervical can cause menstrual cycle because of an alteration with their physiology.
Inherited bleeding disorders – bleeding can be caused by hereditary that had problems in their coagulations. Such conditions are very common with individuals who have Willebrand’s.
Uterine Fibroids – these are non-cancerous tumors found in the uterus but this usually alters the normal physiology of the uterus because it can cause blockage and deprivation of proper circulation. Fibroids are usually noted during pregnancy.
Uterine Polyps – these are the small, benign growing in lining of the uterus which increases the potential for bleeding. This is als d/t to increase levels in the hormones.
Adenomyosis – condition called endometrium is noted, where the lining of the uterus’ muscle is surrounded.
Intrauterine Devices (IUDs) – misplacement or scarring from this contraceptive device. It also affects the hormone levels since it is a birth control device. Infection can also be noted if this is not properly use by women.
Pregnancy Complications – abortions or miscarriages that are not properly curettage will be prone to having small clots or debris inside the uterus which causes infection and can lead to bleeding.
Medications – there are medications that can alter the blood coagulation which can cause bleeding or hemorrhage. These are usually d/t anti-coagulants.
Other medical conditions – these are the usually the secondary complications that arises from the first patients diagnosis.

Different Diagnosis

The patient has to undergone series of test to know the medical history and abnormalities in the patients health condition specially when it comes to the menstrual cycle:

Blood tests – since there is bleeding noted, the test will check if there is an alteration with the blood coagulation, anemias and other medical conditions that can affect the blood properties
Pap Smear Tests – to check if there are cancerous cells or inflammations that causes the bleeding.
Endometrial Biopsy – to diagnose if there are muscles or linings that affects the functions of the uterus. It also serves as a test to check if there are tumors or other cell growths.
Ultrasound – to see if there are abnormal foreign objects or tumor growth inside the uterine area.
Sonohysterogram
Hysteroscopy

Treatment

Surgical Treatments & Procedures

Dilation and Curettage (D & C) – this procedure aids in removing the molded blood clots and other left fibroids. This is usually the common the procedure to remove the unborn child when the women had an abortion or miscarriages.
Uterine Artery Embolization – this is to remove embolism and thrombosis where blood clots can be noted because of the increase in bleeding
Ultrasound Ablation – to remove the tumors or parts or noted foreign linings in the uterus
Myomectomy – removal of linings surrounding the uterine muscle. Commonly done with patient who have endometrium
Endometrial Ablation – removal of the uterine layer to stop the excessive and abnormal bleeding which is common to pregnant women
Hysterectomy – removal of the uterus specially when the uterus is already causing too much complications and bleeding in the body

Medications

Iron supplements – to avoid IDA and other means of anemia
NSAIDS or analgesics – for pain noted (Advil, Ibuprofen,
Oral contraceptives – to regulate the hormone levels

Complications

If not given importance, consultation and treatment advised by the doctor, the patient may experience the following complications: ^[2]

Vaginal hemorrhage (increase bleeding)
Bleeding between periods will be noted
Vaginal bleeding is noted even after menopause
Iron Deficiency Anemia
Painful menstruation (dysmenorrhea)

References

http://www.nhs.uk/conditions/Periods-heavy/Pages/Introduction.aspx
http://www.webmd.com/women/guide/heavy-period-causes-treatments
http://www.mayoclinic.org/diseases-conditions/menorrhagia/basics/definition/con-20021959