Menorrhagia is defined as excessive
menstrual blood loss which interferes with
a woman's physical, social, emotional
and/ or material quality of life. It can occur
alone or in combination with other
symptoms. (rwcE Guidance 2016).
The signs and symptoms of menorrhagia may
Soaking through one or more sanitary pads or
tampons every hour for several consecutive
Needing to use double sanitary protection to
control your menstrual flow
Needing to wake up to change sanitary
protection during the night
Bleeding for longer than a week
Passing blood clots with menstrual flow for more
than one day
Restricting daily activities due to heavy
Symptoms of anemia, such as tiredness, fatg
or shortness of breath
When to see a doctor
Vaginal bleeding so heavy it soaks at
least one pad or tampon an hour for
more than a few hours
Bleeding between periods or irregular
Any vaginal bleeding after menopause
Dysfunction of the ovaries.
Intrauterine device (IUD).
9. Inherited bleeding disorders.
11. Other medical conditions.
9°. “.°". °‘. "‘. °°. "’. "
1. Hormone imbalance. If a hormone
imbalance occurs between the hormones
estrogen and progesterone, the
endometrium develops in excess and
eventually sheds by way of heavy
2. Dysfunction of the ovaries. If ovaries don't
ovulate during a menstrual cycle
(anovu| ation), body doesn't produce the
hormone progesterone, as it would during
a normal menstrual cycle. This leads to
hormone imbalance and may result in
3. Uterine fibroids. These noncancerous
(benign) tumors of the uterus appear
during childbearing years.
Polyps. Small, benign polyps may cause heavy or
prolonged menstrual bleeding.
Adenomyosis. often causing heavy bleeding and
Intrauterine device (IUD). Menorrhagia is a well-
known side effect of using a nonhormonal
Pregnancy complications. miscarriage , ectopic
Cancer. Rarely, uterine cancer, ovarian cancer
and cervical cancer
Inherited bleeding disorders. Von Willebrand's
Medications. anti-inflammatory medications and
Other medical conditions. including pelvic
inflammatory disease (PID), thyroid problems
endometriosis, and liver or kidney disease, may
be associated with menorrhagia.
Adolescent girls who have recently
started menstruating. Gir| s are especially
prone to anovulatory cycles in the first
year after their first menstrual period
Older women approaching
menopause. Women ages 40 to 50 are at
increased risk of hormonal changes that
lead to anovulatory cycles.
A. Iron deficiency anemia. Menorrhagia
may decrease iron levels enough to
increase the risk of iron deficiency
B. Severe pain. with heavy menstrual
bleeding, you might have painful
menstrual cramps (dysmenorrhea).
Tests and diagnosis
Blood tests. evaluate for iron deficiency
(anemia) and other conditions, such as
thyroid disorders or blood-clotting
Pap test. cells from cervix are collected and
tested for infection, inflammation or
Ultrasound scan. For uterus, ovaries and
« Sonohysterogram. During this test, a
fluid is injected through a tube into
uterus by way of vagina and cervix.
using ultrasound to look for problems in
the lining of uterus.
~/ Hysteroscopy. This exam involves
inserting a tiny camera through vagina
and cervix into uterus, which allows to
see the inside of uterus.
Treatments and drugs
« Iron supplements. If have anemia,
recommend iron supplements regularly.
« Nonsteroidal anti-inflammatory
drugs. NSA| Ds, such as ibuprofen or
naproxen (Aleve), help reduce menstrual
blood loss. NSA| Ds have the added benefit
of relieving painful menstrual cramps
« Tranexamic acid. Tranexamic acid helps
reduce menstrual blood loss.
« Oral contraceptives. oral contraceptives can
help regulate menstrual cycles and reduce
episodes of excessive or prolonged menstrual
« Oral progesterone. the hormone progesterone
can help correct hormone imbalance and
« The hormonal IUD (Mirena). This releases a
type of progestin called levonorgestrel, which
makes the uterine lining thin and decreases
menstrual blood flow and cramping.
‘.1 Dilation and curettage (D&C).
_I Uterine artery embolization. menorrhagia
caused by fibroids, the goal is to shrink any
fibroids in the uterus by blocking the uterine
arteries and cutting off their blood supply.
:1 Focused ultrasound ablation. Similar to
uterine artery embolization, focused
ultrasound ablation treats bleeding caused
by fibroids by shrinking the fibroids. This
procedure uses ultrasound waves to destroy
the fibroid tissue. no incisions required for
Myomectomy. surgical removal of uterine
Endometrial ablation. permanently destroying
the lining of uterus (endometrium).
Endometrial resection. This surgical procedure
uses an electrosurgical wire loop to remove
the lining of the uterus. Both endometrial
ablation and endometrial resection benefit
women who have very heavy menstrual
bleeding. Pregnancy isn't recommended after
Hysterectomy. Hysterectomy — surgery to
remove your uterus and cervix — is a
permanent procedure that causes sterility and
ends menstrual periods.