Menorrhagia (heavy menstrual bleeding) – blood loss during menstruation, exceeding the physiological norm (~ 150 ml). It can serve as a manifestation of inflammatory processes of the female genital sphere, uterine fibroids, ovarian dysfunction, neuropsychiatric fatigue. Entails the development of anemia, disability and quality of life of a woman. Other complications depend on the cause of the underlying disease. Menorrhagia is diagnosed according to anamnesis, gynecological examination, ultrasound of the pelvic organs. If necessary, a biopsy and cytological examination are performed. Treatment can be therapeutic and surgical.
Menorrhagia is one of the variants of hypermenstrual syndrome (heavy menstrual bleeding), in which regular menstrual bleeding lasts for more than 7 days, and blood loss is more than 100-150 ml. Copious and prolonged menstruation worries about 30% of women, however, not all turn to the gynecologist with the problem. There are primary menorrhagia that occurs simultaneously with the first menstruation, and secondary – developing after a period of normal menstruation.
Causes of menorrhagia
The reasons leading to the development of this disease may be the following violations:
- Hormonal instability. It is especially pronounced in patients of pre-menopausal and transitional age. The instability of the hormonal background during these physiological periods increases the risk of menorrhagia.
- Diseases of the reproductive system: fibroids, polyps, uterine adenomyosis, ovarian dysfunction. They develop due to hormonal imbalance in the body and cause menorrhagia in 80% of women.
- The use of intrauterine contraceptives. Disease in this case is an undesirable side effect that may require removal of the IUD (intrauterine device).
- Diseases associated with a violation of the blood clotting system (for example, vitamin K deficiency, thrombocytopenia), as well as taking certain medications that affect clotting (anticoagulants). Increased bleeding, accompanying disorders of the blood clotting system, can manifest itself with copious menstruation – menorrhagia.
- Hereditary menorrhagia. Menorrhagia is often a family disease transmitted through the female line of inheritance.
- Diseases of the pelvic organs, thyroid gland, kidneys, liver, heart. In menorrhagia, the patient should consult with an endocrinologist and therapist to exclude endocrine and general somatic causes of heavy menstrual bleeding.
- Excessive power loads, overwork, stressful situations, changes in climatic conditions are all factors that force the body to adapt to new conditions and loads, can provoke the development of menorrhagia.
Symptoms of menorrhagia
The main manifestation is prolonged and copious menstrual discharge with blood clots. Prolonged and severe blood loss can lead to anemia, manifested in deterioration of well-being, weakness, dizziness, the development of fainting states. Often, disease causes bleeding from the gums and nose, bruises, bruises on the body. With menorrhagia, menstruation is so abundant that a woman is forced to replace a sanitary swab or pad every hour, and sometimes more often.
The diagnosis of menorrhagia is based on complaints and signs of excessive blood loss. With any uterine bleeding, pregnancy is excluded, especially ectopic. Pregnancy and related pathology can be excluded by a pregnancy test – determination of chorionic gonadotropin in the blood.
To diagnose menorrhagia, anamnesis data are important (taking medications, complications of previous pregnancies and childbirth, etc.). To find out the causes of menorrhagia, the vagina and cervix are examined for the presence of foreign bodies, traumatic injuries, polyps, tumors, inflammatory or atrophic changes.
In case of suspected pathology of the uterus and ovaries, diagnostic procedures are performed: ultrasound of the pelvic organs, hysteroscopy, cervical biopsy, curettage and analysis of endometrial tissue. Hemoglobin is examined by laboratory diagnostic methods for menorrhagia, a biochemical blood test and coagulogram are performed, hormonal background is determined, cancer markers CA 19-9, CA-125. To detect precancerous or cancerous cells in the cervix, a cytological analysis of a Pap smear is performed.
Women suffering are recommended to maintain a menstrual calendar, which notes the duration of menstruation, the abundance and nature of secretions. The abundance of blood loss is determined by the frequency of changing the pad or tampon.
The method of treating menorrhagia is chosen depending on the cause, abundance and duration of menstrual bleeding. Self-treatment of menorrhagia can only worsen the disease.
As a drug therapy for menoragia, long-term hormonal contraception is prescribed to regulate the hormonal balance. Progesterone and estrogen, which are part of oral contraceptives, prevent excessive growth of the endometrium and reduce the amount of discharge during menstruation by more than 40%. The selection of oral contraceptives is carried out at the consultation of a gynecologist on an individual basis.
Women with menorrhagia are recommended to take iron supplements to avoid iron deficiency anemia. Taking rutin and ascorbic acid will help reduce blood loss. Anti-inflammatory drugs (ibuprofen) are used to treat menorrhagia, affecting the duration and amount of bloody discharge. With severe bleeding, hemostatic drugs are prescribed – ethamzylate, calcium chloride or gluconate, aminocaproic acid. In case of hormonal imbalance, homeopathic treatment is effective.
Intrauterine systems with levonogestrel are used to treat menorrhagia. Having a contraceptive effect, they prevent the proliferation of the endometrium, reduce its thickness and blood supply. However, if disease is caused by the use of an intrauterine contraceptive, then it should be removed and other methods and means of protection should be used. Women recommended to normalize the regime, complete rest and nutrition. After the cessation of menstrual bleeding, a course of physiotherapy procedures is carried out (10-15 sessions of ozokeritis and diathermy). Some cases of menorrhagia require surgical intervention.
Surgical gynecology treats menorrhagia according to the following indications:
- recurrent course of menorrhagia;
- physiological disorders or damage to the genitals;
- ineffectiveness of the ongoing medical treatment of menorrhagia;
- severe iron deficiency anemia.
For diagnostic and therapeutic purposes, hysteroscopy is performed for menorrhagia, which allows diagnosing any pathology of the uterus (for example, endometrial polyps) and eliminating it. Curettage of the uterine cavity allows for several menstrual cycles to reduce bleeding, after which menorrhagia resumes again.
With prolonged and copious menstrual bleeding or in the presence of fibromyoma and polyps, hysterectomy is resorted to – surgical removal of the uterus. In some cases, it is possible to perform its supravaginal amputation. Surgical treatment of menorrhagia is used in women over 40 years of age, at a younger age – only in particularly severe cases. Thyroid diseases and tumors that cause menorrhagia are treated either medicinally or surgically.
Menorrhagia in adolescents
Since hormonal instability is characteristic of adolescents, menorrhagia is often found in girls aged 13-16. The main cause of adolescent menorrhagia is a violation of the balance between progesterone and estrogen levels, which affect the maturation and rejection of the endometrium of the uterus. The burdened course of menstruation can develop in cases of an enlarged thyroid gland, poor blood clotting, infections of the genital tract. A common cause of adolescent menorrhagia is hereditary forms of coagulopathy (hemostasis disorders).
Adolescents suffer menorrhagia especially hard and require immediate medical advice in order to determine the causes and correction of disorders. In the absence of treatment in adolescents, 30% later develop polycystic ovaries.
Her mother should come to the initial consultation with the girl and inform the doctor about the family history, the course of pregnancy and the diseases suffered by the child. The doctor evaluates the anthropometric data of the patient (height, weight), the degree of development of secondary sexual characteristics to exclude pathological processes affecting the development of the girl. The time of the onset of menstruation, the peculiarities of the course and characteristics of the menstrual cycle (cycle duration, duration, profusion and painfulness of menstrual bleeding, etc.) are clarified. Attention is paid to the influence of menstruation on the general well-being and performance of the girl (whether she misses training sessions due to menorrhagia, whether she is engaged in sports sections, etc.). This information is an important indicator of both the general and gynecological health of a teenager.
Mandatory for menorrhagia in adolescents is a study of the hemoglobin content of the blood to detect anemia. In the presence of iron deficiency anemia in patients with menorrhagia, iron preparations are prescribed. To regulate the menstrual cycle in adolescent menorrhagia, low-dose hormonal contraceptives containing no more than 35 micrograms of the estrogen component in 1 tablet of the drug are used. It will be useful to teach the girl to keep a menstrual calendar with the fixation of the characteristics of the menstrual cycle.
The effectiveness of the result of menorrhagia treatment is estimated after about 6 months, and its indicator is the restoration of the normal volume of menstrual bleeding. In the future, follow–up with a gynecologist is standard – 2 times a year.
Menorrhagia, even if it does not serve as a manifestation of a serious and dangerous disease, gives a woman a lot of inconvenience and significantly worsens her quality of life. As preventive measures for the development of pathology, women are advised to refrain from excessive physical exertion, power sports, avoid overwork, stress, and sudden changes in climatic conditions. In case of ineffectiveness of these measures and deterioration of well-being, treatment to a doctor should be immediate.
For the prevention of menorrhagia, it is useful to take multivitamin complexes, including B vitamins, vitamin C, folic acid and iron. Regular filling of the menstrual calendar will help determine the moment of the appearance of menorrhagia, which will allow timely diagnostic and therapeutic measures.
Bleeding is always an urgent condition. Therefore, delaying a visit to a doctor with the development of menorrhagia, a woman independently aggravates the severity of anemia, increases the risk of endometritis, worsens the state of the blood clotting system.