Menorrhagia - Symptoms, causes and treatment

Menorrhagia is a medical term to describe the amount of blood that comes out when menstruation is excessive or menstruation lasts for a long time more than 7 days. This condition can interfere with daily activities to affect the quality of life of the sufferer.

During menstruation, the amount of blood that is considered normal is about 30-40 ml per cycle. A woman is considered to have excessive menstruation if the amount of blood she passes is more than 80 ml (about 16 teaspoons) per cycle.

One of the benchmarks that can be used is the frequency or frequency of changing pads. If during menstruation, changing pads filled with blood is done less than every 2 hours, there is a possibility that you have menorrhagia.

Symptoms of Menorrhagia

Menstruation is the process of shedding of the uterine wall which is marked by bleeding from the vagina. Normally, menstruation will occur every 21-35 days, the duration is 2-7 days per cycle, with the amount of blood that comes out 30-40 ml (about 6-8 teaspoons) per cycle.

However, in a state of menorrhagia, the duration of menstruation will be prolonged and the amount of blood that comes out will be more than normal.

Some of the symptoms that can appear are:

  • The blood that comes out fills 1 or 2 pads every hour, for several hours straight.
  • Need to change pads while sleeping at night.
  • The duration of bleeding is more than 7 days.
  • The blood that comes out is accompanied by blood clots the size of a coin or more.
  • The blood that comes out is too much to interfere with daily activities.

In addition, menorrhagia can also be accompanied by pain in the lower abdomen during menstruation.

When to go to the doctor

Consult a doctor if symptoms appear as mentioned above, especially if these symptoms have interfered with daily activities.

You are advised to go to the doctor immediately if during menstruation you experience:

  • Dizziness especially when standing.
  • Confusion.
  • Abdominal pain, nausea, and vomiting.

Regular check-ups with the doctor may be recommended to monitor the progress of the condition.

Causes of Menorrhagia

Not all causes of menorrhagia can be identified. However, there are several conditions that generally trigger the occurrence of menorrhagia, namely:

  • Hormone imbalances, for example due to polycystic ovary syndrome, obesity, hypothyroidism, and insulin resistance.
  • Disorders or growth of tissue in the uterus, such as pelvic inflammation, fibroids (uterine fibroids), endometriosis, adenomyosis, uterine polyps,
  • Disorders of the ovaries, causing the ovulation process to not occur as it should.
  • Genetic disorders, especially those that affect blood clotting, such as von Willebrand's disease.
  • Side effects of drugs, such as anti-inflammatory drugs, hormone drugs, anticoagulants, drugs used in chemotherapy, and herbal supplements containing ginseng, ginkgo biloba, and soy.
  • Contraceptives, such as birth control pills and IUDs (spiral contraception).
  • Cancer, such as uterine or cervical cancer.

Diagnosis of Menorrhagia

The doctor will take a history or ask questions about the symptoms experienced, the history of drug use, as well as the patient's and family's medical history.

After that, a physical examination will be carried out, especially in the abdominal area and feminine area, including using a speculum to see the cervix.

In order to determine the underlying cause of menorrhagia, some further tests can also be done, such as:

  • Blood tests, to detect anemia, thyroid hormone disorders or blood clotting disorders.
  • Pap smear, to check for signs of inflammation, infection, or potential cancer by taking a sample of cells from the inner wall of the cervix.
  • Biopsy, by taking a sample of tissue from the uterus to be examined under a microscope.
  • Ultrasound of the uterus, which is a scan to visually check for fibroids, polyps, or other abnormalities.
  • Sonohysterography (SIS), to detect disturbances in the lining of the uterine wall by using a dye that is injected into the uterus.
  • Hysteroscopy, to see the condition of the patient's uterus by inserting a thin tube equipped with a special camera that is inserted through the vagina.
  • Dilation and curettage (curettage), to determine the cause of bleeding by taking a sample of the uterine wall.

Menorrhagia Treatment

Menorrhagia treatment aims to stop bleeding, treat the cause, and prevent complications. Treatment will be determined based on the cause of the menorrhagia and the severity of the condition.

The doctor will also consider the patient's age, general health condition, medical history, and personal needs, such as planning a pregnancy.

Here are some ways that can be used to treat menorrhagia:

Drugs

Some types of drugs that can be used to treat menorrhagia are:

  • Antifibrinolytic drugs, such as tranexamic acid, to help the blood clot.
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, and mefenamic acid, to relieve pain symptoms and decrease the production of prostaglandins that can trigger menorrhagia.
  • Combined contraceptive pills, to regulate the menstrual cycle and reduce the duration and amount of blood that comes out during menstruation.
  • Desmopressin, to treat the cause of bleeding in von Willebrand's disease.
  • Injectable progestogens and norethisterone orally (drugs), to help balance hormone levels and reduce the amount of bleeding.
  • GnRH-a . analogues (gonadotropin releasing hormone analogue), to reduce bleeding during menstruation, improve the menstrual cycle, relieve menstrual symptoms, reduce the risk of pelvic inflammation, and prevent cancer.

If menorrhagia causes anemia, the doctor will provide iron supplements.

Operation

A surgical procedure will usually be recommended by a doctor if menorrhagia can no longer be treated with drugs and to treat the underlying cause of menorrhagia. Some types of procedures that can be done include:

  • Dilation and curettage (D&C)

    The doctor will dilate (open) the cervix and perform a curettage (scraping) of the uterine wall to reduce bleeding during menstruation.

  • Uterine artery embolization

    This procedure is done to treat menorrhagia caused by fibroids. In this procedure, myoma is reduced by blocking the arteries that supply blood to the tumor.

  • myomectomy

    In this procedure, the fibroids that cause excessive menstruation are surgically removed. In some cases, fibroids can grow back even after a myomectomy has been performed.

  • Endometrial resection

    This procedure is performed to remove the endometrium using hot wires. After undergoing this procedure, the patient is not recommended to become pregnant.

  • Endometrial ablation

    This procedure is performed by destroying the endometrial lining permanently, either by laser, radiofrequency (RF), or by heating.

  • Hysterectomy

    This surgical removal of the uterus will stop menstruation forever and make the patient unable to conceive. Usually, this procedure is taken when menorrhagia can no longer be treated in other ways.

Complications and Prevention of Menorrhagia

Excessive menstruation can cause complications in the form of iron deficiency anemia which is characterized by headaches, dizziness, shortness of breath, and palpitations. This condition can also cause dysmenorrhea (painful menstruation) that is severe enough to require medical attention.

Menorrhagia is difficult to prevent because there are many causes. The best thing to do is to check with your doctor if you have any of the risk factors above. That way, the doctor can provide early treatment if you experience excessive menstruation.