Polymenorrhea is a disorder of the menstrual cycle in which menstruation becomes excessively abundant and prolonged. Menstrual rhythm in polymenorrhea is usually preserved, but a large monthly blood loss leads to the development of asthenic and anemic syndromes. To identify the causes of polymenorrhea, gynecological examination, laboratory tests (blood analysis, smear examination, hormone determination), echography of the pelvic organs, hysteroscopy are performed. The principles of treatment of polymenorrhea provide for conservative or surgical elimination of its causes, correction of iron deficiency anemia.
Polymenorrhea is a type of menorrhagia, or hypermenstrual syndrome, which is characterized by an increase in the duration and intensity of menstruation. Quantitative criteria for polymenorrhea are menstrual blood loss > 150 ml and the duration of menstruation over 7 (but not more than 12) days. The rhythmicity of the menstrual cycle in this condition is not disturbed. In some cases, polymenorrhea is combined with proyomenorrhea – frequent menstrual bleeding, the interval between which is less than 21 days. The reliable population frequency of polymenorrhea is unknown. According to the data available in the literature, polymenorrhea accounts for about 19% of menstrual disorders in adolescence; in reproductive age, it occurs in 50% of patients with uterine fibroids, develops in 3.7–9.6% of women with an installed intrauterine device.
Polymenorrhea syndrome can occur against the background of various genital and extragenital diseases. In most cases, the etiological basis for such menstrual disorders are intrauterine pathological processes: endometriosis, submucous and interstitial fibroma, metroendometritis. Excessive overgrowth (hyperplasia) of the endometrium and its prolonged rejection is usually caused by hyperestrogenism. An increase in the duration and intensity of menstrual bleeding may be associated with anomalies in the position of the uterus, primarily its retroflexia, as well as the use of intrauterine contraceptives.
In addition to pathological causes, polymenorrhea can be caused by physiological processes occurring in the female body at various age periods. So, during puberty, hypermenstrual syndrome is explained by the formation of hormonal function of the ovaries, and during menopause – its extinction.
Hormonal dysfunction can be caused by extragenital causes, including liver and thyroid diseases, tuberculosis, cardiovascular pathology, etc. Disorders of the blood coagulation system (for example, thrombocytopenic purpura, vitamin K deficiency) have an indirect effect on the nature of menstruation. Sometimes menstrual disorders such as polymenorrhea are provoked by prolonged stress or emotional overstrain.
Clinical signs of polymenorrhea are:
- Cyclical menstrual bleeding (menstruation is repeated at regular intervals)
- Prolonged menstrual bleeding (longer than 7, but not more than 12 days)
- Excessively strong menstrual bleeding. Menstruation is considered abundant, in which a woman is forced to change sanitary pads every hour or more often. In quantitative terms, monthly blood loss can reach 200-250 ml or more.
Polymenorrhea can be combined with menstrual cramps, and menstrual secretions contain blood clots. As a result of prolonged and intense menstrual bleeding, general well-being is disturbed, asthenic syndrome and anemia develop. Patients complain of increased fatigue and irritability, weakness, drowsiness, decreased libido, weight loss. Signs of iron deficiency anemia are dizziness, pallor of the skin, fainting during menstruation.
Given the variety of causes of polymenorrhea, the diagnostic search may lie not only in the field of gynecology, but also in endocrinology, hematology and other medical areas. First of all, at the reception, the gynecologist finds out the features of menstrual function, changes in the nature of menstruation, collects a detailed obstetric and gynecological history.
It is possible to detect the presence of inflammatory processes and uterine fibroids already during a gynecological examination. The condition of the endometrium and ovaries is assessed during ultrasound of the pelvic organs. To exclude the infectious etiology of polymenorrhea, smears are taken with their microscopic, bacteriological assessment, PCR examination. Also, additional information about the causes of polymenorrhea is provided by determining the level of sex hormones, thyroid hormones, liver tests. Clinical blood analysis allows to assess the degree of iron deficiency anemia.
If endometriosis is suspected, hyperplastic processes in the endometrium may require hysteroscopy with separate diagnostic curettage and histological examination of the mucous layer.
Treatment and prevention
Depending on the identified concomitant disorders, various treatment options for polymenorrhea syndrome are possible. If the cause of the pathology was hormonal dysfunction, combined oral contraceptives are selected. In patients with polymenorrhea associated with adenomyosis and uterine fibroids, the installation of an intrauterine levonorgestrel-releasing system “Mirena” or the use of a hormonal contraceptive ring “NuvaRing” gives a good therapeutic effect.
The use of hemostatic agents (dicinone, tranexamic acid) is aimed at symptomatic stopping of bleeding. In order to compensate for iron deficiency, antianemic therapy is prescribed. In addition, the intake of folic acid, vitamins B and C. An important role in the normalization of well-being is played by a full diet, a rational work and rest regime.
Increased menstrual blood loss due to uterine fibromyoma is an indication for surgical treatment – conservative myomectomy, supravaginal amputation of the uterus or hysterectomy (removal of the uterus is more often used in women over 40 years old who have realized their reproductive potential). In case of detection of uterine polyps, hysteroresectoscopy of the polyp is performed.
Polymenorrhea not only causes a lot of inconvenience to a woman, but also indicates serious problems with reproductive health. Regular gynecological examinations, timely treatment of genital and extragenital pathology allow to prevent menstrual disorders. Every woman should carefully monitor her health, keep a menstrual calendar, in which it is necessary to note the duration and volume of secretions.