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DESCRIPTION
Menorrhagia is a fairly common disorder that is characterized by an unusually heavy or prolonged period of menstrual flow. Almost every woman at some time in her reproductive life experiences heavy bleeding during her menstrual period. The condition is also known as hypermenorrhea.
The menstrual cycle isn't the same for every woman. Normal menstrual flow occurs about every 28 days and lasts from 4 to 5 days. The average amount of blood loss during a normal menstrual period is about two ounces (some resources say between 60 to 250 ml or 4 tablespoons to about 1 cup. With menorrhagia, a woman may lose three ounces or more. Your period may be regular or irregular, light or heavy, painful or pain-free, long or short and still be considered normal.
Although heavy menstrual bleeding is a common concern among pre-menopausal women, only a few women experience blood loss severe enough to be defined as menorrhagia. It rarely signifies a serious underlying disorder.
FREQUENT SIGNS & SYMPTOMS
Excessive menstrual flow (varies greatly from woman to woman). Menstrual flow that soaks through one or more sanitary pads or tampons every hour for several consecutive hours. The need to use double sanitary protection to control your menstrual flow. The need to change sanitary protection during the night.
Menstrual period lasts for more than 7 days.
Passing of large clots of blood.
Heavy menstrual flow that interferes with your regular lifestyle.
Constant pain in your lower abdomen during menstrual period.
Irregular menstrual periods.
Paleness, shortness of breath, tiredness and fatigue (anemia symptoms).
MoonDragon's Anemia Index for Various Types of Anemia
CAUSES
Imbalance of female hormones (estrogen and progesterone). In a normal menstrual cycle, a balance between the hormones estrogen and progesterone regulates the buildup of the lining of the uterus (endometrium), which you shed during menstruation. If a hormonal imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding. Hormonal imbalance occurs most often in adolescent girls experiencing their menstrual periods for the first time and in women approaching menopause. Menorrhagia caused by certain conditions involving hormonal imbalance, such as thyroid disease, often can be controlled with hormone medications. However, improper use of hormone medications can also be a direct cause of menorrhagia.
Fibroids (benign uterine tumors). These non-cancerous (benign) tumors of the uterus appear during your childbearing years. Uterine fibroids may cause heavier than normal or prolonged menstrual bleeding.
Peri-menopause will sometimes have symptoms of excessive bleeding, clotting, and flooding (lots of blood over a short period of time).
Together hormonal imbalance and uterine fibroids account for about 80 percent of all cases of menorrhagia.
Anovulation (failure to release an egg each month). Dysfunction of the ovaries which the failure of the ovaries to produce, mature or release eggs may cause hormonal imbalances and result in menorrhagia.
Ovarian cysts. These fluid-filled sacs or pockets occur within or on the ovary. Ovarian cysts are often benign and rarely cause menstrual irregularities, including menorrhagia.
Pelvic inflammatory disease and other pelvic infections. Pelvic infections, pelvic inflammatory disease may cause menorrhagia. Reproductive system infections caused by a sexually transmitted disease (STD) may cause heavy or prolonged menstrual bleeding.
Pregnancy complications such as a single heavy period that is late may be due to a miscarriage. Bleeding (and infection) may occur from a miscarriage that was not complete (the entire fetal/embryonic remains were not expelled at the time of fetal/embryonic demise). Ectopic pregnancy, implantation of a fertilized egg within the fallopian tube instead of the uterus, also can cause abnormal or prolonged bleeding (menorrhagia).
Endometriosis and other endometrial disorders. Adenomyosis is a condition that occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding and pain. Adenomyosis is most likely to develop if you are a middle-aged women who has had many children.
Intrauterine device (IUD). Menorrhagia is a well-known side effect of using an IUD for birth control. When an IUD is the cause of excessive menstrual bleeding, you will often need to remove it and find another from of birth control. Light spotting is normal with the use of an IUD and, with no other symptoms present, is most likely insignificant.
Hypothyroidism.
Polyps. The development of small benign growths on the uterine wall (uterine polyps) may cause heavy or prolonged menstrual bleeding. Polyps of the uterus most commonly occurs in women of reproductive age as the result of excessive hormone production or consumption and can lead to bleeding not associated with menstruation (spotting).
Cancer. Rarely, certain female reproductive cancers may cause menorrhagia. Uterine cancer, ovarian cancer and cervical cancer can cause excessive vaginal bleeding.
Medications. Certain drugs including those that prevent blood clotting (anti-coagulants) and anti-inflammatory medications, can contribute to heavy or prolonged menstrual bleeding.
Other medical conditions may cause or increase your risk of menorrhagia. These include lupus, liver or kidney disease, some uncommon blood disorders, certain cancers and chemotherapy may cause menorrhagia.
RISK INCREASES WITH
Obesity.
Estrogen administration (without progestin).
Young women who have not established a regular ovulation cycle may be especially prone to menorrhagia in the 12 to 18 months after their first menstrual period (menarche).
Women approaching menopause often experience hormonal imbalance that can cause menorrhagia.
Women at higher risk also include those with hereditary bleeding disorders.
PREVENTIVE MEASURES
Annual pelvic examinations with a cervical smear test (Pap smear) is usually recommended by allopathic medical approaches. Sexually active women and women over the age of 18 should have yearly pelvic exams and regular pap tests.
EXPECTED OUTCOME
Outcome varies with cause of bleeding.
Women with hormonal causes usually respond to treatment.
POSSIBLE COMPLICATIONS
Excessive or prolonged menstrual bleeding can lead to other medical conditions, including:
Iron Deficiency Anemia due to excessive blood loss. In this common type of anemia, your blood is low on healthy red blood cells, which carry oxygen to tissues. Oxygenated blood gives your body both energy and your skin a healthy color. Menorrhagia is the most common cause of anemia in pre-menopausal women. Some women in their reproductive years have iron levels low enough to cause anemia. Iron deficiency anemia is due to insufficient iron. Your body needs iron to make hemoglobin, a substance in red blood cells that enables them to carry oxygen.
Although diet plays a role in such cases, the problem is complicated by heavy menstrual periods. Most cases of anemia are mild, but even mild anemia can cause weakness and fatigue. Moderate to severe anemia can also cause shortness of breath, rapid heart rate, headaches, ringing in the ears (tinnitus), irritability, pale skin, restless legs syndrome and mental confusion. Heart problems can occur in prolonged and severe anemia that's left untreated. Pregnant women who are anemic, particularly in the first trimester, have an increased risk of a poor pregnancy outcome.
Severe pain. Heavy menstrual bleeding often is accompanied by menstrual cramps (dysmenorrhea). Although most women choose at-home treatment for the menstrual pain that menorrhagia can bring, others may have more severe pain and need to seek medical relief through prescription medication or a surgical procedure.
Infertility. Many conditions associated with menstrual irregularities, including heavy bleeding, ovulation abnormalities, uterine fibroids and endometriosis, are major contributors to female infertility. Irregular periods from any cause may make it more difficult to conceive.
Toxic shock syndrome. Keeping a tampon in place for more than eight hours increases the risk of infection and toxic shock syndrome, a rare but potentially life-threatening condition caused by bacteria that adhere to tampons and produce toxins. Signs and symptoms include very high fever, diarrhea, sore throat and extreme weakness. A peeling rash may develop, usually on the hands and feet. Blood pressure may drop to dangerous levels.
Surgery, such as a hysterectomy (removal of the uterus) may be required or other surgical procedures may need to be performed, depending upon the cause and severity of menorrhagia.
TREATMENT
GENERAL MEASURES
DIAGNOSIS
Your health care provider may likely ask you about your medical history and menstrual cycles. You may be asked to keep a diary of bleeding and non-bleeding days, including notes on how heavy your flow was and how much sanitary protection you needed to control it. Your health care provider will do a physical exam and may recommend one or more tests or procedures. Special medical diagnostic tests (e.g. pregnancy test, endometrial biopsy, blood tests) to help determine cause of bleeding may be performed.
- Blood tests - A sample of your blood is evaluated for any abnormalities due to excessive blood loss during menstruation.
- Pap test - Your health care provider collects cells from your cervix for microscopic examination to detect infection, inflammation or changes that may be cancerous or may lead to cancer.
- Endometrial biopsy - This is a procedure whereas you health care provider takes a sample of tissue from inside your uterus to be examined under a microscope.
- Ultrasound scan - This method of scan uses sound waves to produce pictures of your uterus, ovaries and pelvis.
- Sonohysterogram - This ultrasound scan is done after fluid is injected through a tube into the uterus by way of your vagina and cervix. This allows your health care provider to look for problems in the lining of the uterus.
- Hysteroscopy - A tiny tube with a light is inserted through your vagina and cervix into the uterus, which allows your health care provider to see the inside of your uterus.
- Dilation and Curettage (D and C) - In this procedure, you health care provider opens (dilates) your cervix and then inserts a spoon-shaped instrument (curette) into your uterus to collect tissue from the lining of your uterus to be examined in the laboratory. Dilation and curettage, often referred to as a D & C (dilation of the cervix and a scraping out of the uterus with a curette) may be performed.
- Hysterosalpingography - A dye is injected into your uterus and fallopian tubes through the cervix, and x-rays are taken to determine the shape and size of your uterus and fallopian tubes.
Health care providers can be certain of a diagnosis of menorrhagia only after ruling out other menstrual disorders, medical conditions or medications as possible causes or aggravation of this condition.
TREATMENT
Specific treatment for menorrhagia is based on a number of factors, including:
- Your overall health and medical history.
- The extent of the condition.
- The cause of the condition.
- Your tolerance for specific medications, procedures or therapies.
- Your health care provider's expectations for how the condition will progress.
- Effects of the condition on your lifestyle.
- Your opinion or personal preference.
Drug therapy for menorrhagia may include:
- Iron supplements. If the condition is accompanied by anemia, your health care provider may recommend that you take iron supplements regularly. If your iron levels are low but you're not yet anemic, you may be started on iron supplements rather than waiting until you become anemic.
- Prostaglandin inhibitors. These include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, others) to help reduce cramping and blood flow.
- Oral contraceptives. Aside from providing effective birth control, oral contraceptives can help regulate ovulation and reduce episodes of excessive or prolonged menstrual bleeding.
- Progesterone. The hormone progesterone can help correct hormonal imbalance and reduce menorrhagia.
If you have drug-induced menorrhagia from taking hormone medication, you and your health care provider may be able to treat the condition by changing or stopping your medication.
You may need surgical treatment for menorrhagia if drug therapy is unsuccessful. Treatment options include:
- Dilation and curettage (D and C). In this procedure, your health care provider opens (dilates) your cervix and then scrapes or suctions tissue from the lining of your uterus to reduce menstrual bleeding. Although this procedure is common and often treats menorrhagia successfully, you may need the procedure repeated if menorrhagia recurs.
- Operative hysteroscopy. This procedure uses a tiny tube with a light (hysteroscope) to view your uterine cavity and can aid in the surgical removal of a polyp that may be causing increased menstrual bleeding.
- Endometrial ablation. Using ultrasonic energy, your health care provider permanently destroys the entire lining of your uterus (endometrium). After endometrial ablation, most women have normal menstrual flow. However, some women have little or no menstrual flow after the procedure. Endometrial ablation negatively affects your ability to become pregnant.
- 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 but don't have other underlying uterine problems such as large fibroids, polyps or cancer. Like endometrial ablation, this procedure negatively affects your ability to become pregnant.
- Hysterectomy. Hysterectomy may be considered in persistent cases where fertility is not desired. This surgical removal of the uterus and cervix is a permanent procedure that causes sterility and cessation of menstrual periods. You'll need general anesthesia and hospitalization. Additional removal of the ovaries (total hysterectomy) may cause premature menopause in younger women. Because hysterectomy is permanent, be sure you want this treatment before going ahead with surgery.
Except for hysterectomy, these surgical procedures are usually done on an outpatient basis. Although you'll usually need a general anesthetic, it's likely that you can go home the same day.
Treatment usually depends on the age of the woman, whether or not she desires future pregnancy and on any underlying disorder.
SELF-CARE
Consider these tips for successful self-care of menorrhagia:
- Get your rest. Your health care provider may recommend rest if bleeding is excessive and disruptive to your normal schedule or lifestyle.
- Keep a record. Record the number of pads and tampons you use so that your health care provider can determine the amount of bleeding. Change tampons regularly, at least every four to six hours.
- Avoid aspirin. Because aspirin may promote bleeding, avoid it. Ibuprofen (Advil, Motrin, others) often is more effective than aspirin in relieving menstrual discomforts.
- Wear extra sanitary pads during excessive flow to prevent embarrassment. Note: Using the large incontinence pads helps with "flooding" embarrassments. These pads are extra wide and extra long to allow better coverage than the sanitary pads to capture of excessive flow. These are also wonderful if you will not have a woman's restroom available to change pads or tampons frequently during heavy flow times.
- If using an IUD, have it removed and consider a change to another method of contraception.
MEDICATION
Hormone therapy to control bleeding may be prescribed.
If hormones cannot be taken for some reason, other medications to control the bleeding may be recommended.
Iron replacement therapy may be prescribed for anemia.
ACTIVITY
For some women, menorrhagia is manageable. Follow these tips:
Resting with feet up may be helpful.
Work closely with your health care provider. Stay informed of all aspects of your condition, including controllable causes and new treatment options. Have your blood count and iron level measured at least once a year.
Consider iron supplements. With your health care provider's approval, consider taking an iron supplement to prevent a lack of iron in your blood (iron deficiency anemia).
Take good care of yourself. Eat a healthy diet, get enough rest and exercise, and keep your stress under check.
Seek the support of family and friends. This can help lessen the effects of the condition and make dealing with difficult times more bearable.
DIET
Eat a well-balanced diet. If you are anemic, consider a diet for treating anemia.
MENORRHAGIA SUPPLEMENTAL PRODUCTS
Information, supplements and products for menorrhagia.
Manjistha Powder (Rubia cordifolia), 100% Organic - 8 oz. Bulk
Ayurveda in the maintenance of general health and normal blood circulation. Recent studies revealed that the biologically active constituents of the extract facilitate the free circulation of blood by removing congestion and improving the quality of blood. An infusion of the root has also been prescribed in women after delivery to clear the uterine channels. The best herb for blood purification; blood circulation, controls bleeding, mends broken bones, amenorrhea, cancer, cleanses and regulates liver, spleen, pancreas, and kidneys; diarrhea, dysentery, dysmenorrhea, edema, destroys kidney and gall stones, heart disease, hepatitis, herpes, jaundice, menopause, menorrhagia, painful menstruation, post partum uterus stimulation, paralysis, skin problems, tissue healing, traumatic injuries, skeletal disease, joint pain, rheumatoid arthritis, improves complexion and voice, helps destroy benign and malignant tumors.Vidhari Kand Powder (Ipomoea digitata), 100% Organic - 8 oz. Bulk
Relative to the sweet potato, it is commonly used as a general tonic and in hoarseness of voice, cough, enlarged liver and diminished lactation. Used as a powder, confection, decoction, milk decoction. It is recommended for emaciation in children. It enters into the composition of a compound decoction, which is nutritive, diuretic and expectorant, and useful in fevers and bronchitis. Powdered root is given for diseases of the spleen and liver, for menorrhagia, debility and fat accumulation.Manjistha (Rubia cordifolia), 410mg - 120 Vcaps
Ayurveda in the maintenance of general health and normal blood circulation. Recent studies revealed that the biologically active constituents of the extract facilitate the free circulation of blood by removing congestion and improving the quality of blood. An infusion of the root has also been prescribed in women after delivery to clear the uterine channels. It is used as an immune regulator. (its role in supporting heart health is evidenced by studies that show that it regulates blood pressure, blood vessel constriction and the tendency of blood to form Clots). Its evaluation as an anti cancer compound in the laboratory has been extensive, the extract showing weak activity in vitro and in vivo against standard tumour cell lines. The plant extract shows significant anti-inflammatory activity. The best herb for blood purification; blood circulation, controls bleeding, mends broken bones, amenorrhea, cancer, cleanses and regulates liver, spleen, pancreas, and kidneys; diarrhea, dysentery, dysmenorrhea, edema, destroys kidney and gall stones, heart disease, hepatitis, herpes, jaundice, menopause, menorrhagia, painful menstruation, post partum uterus stimulation, paralysis, skin problems, tissue healing, traumatic injuries, skeletal disease, joint pain, rheumatoid arthritis, improves complexion, helps destroy benign and malignant tumors.Ashokarishta Tonic, 100% Natural - 15 fl. oz.
Ashokarishta is useful in gynecological conditions like menorrhagia, leucorrhea and dysmenorrhea. Ashokarishta is also useful as a uterine tonic. Suggested Use: Dosage: 2 tablespoons mixed with 1/4 cup of water once daily before meals.
Ashokarishta is a very effective treatment for menopausal symptoms, regulating menstruation and menstrual pain and discomforts. Alterative ,stimulant and astringent. Used in leucorrhea, hematuria, and other female conditions.Squaw Vine Tincture, 100% Organic - 2 fl. oz.
Squaw Vine is used as a preparation for childbirth. Squaw Vine is often used for both menstruating and pregnant women. Native Americans used Squaw Vine in the last few weeks of pregnancy to prepare for childbirth. Used for menstrual irregularities (amenorrhea, dysmenorrhea, and menorrhagia) and for vaginal discharge (antiseptic properties for vaginal infections). Suggested Dosage or Use: Take 6-12 drops in liquid or under the tongue, 1-3 times/day.Vidhari Kand (Ipomoea digitata), 450mg - 120 Vcaps
Relative to the sweet potato, it is commonly used as a general tonic and in hoarseness of voice, cough, enlarged liver and diminished lactation. Used as a powder, confection, decoction, milk decoction. It is recommended for emaciation in children. It enters into the composition of a compound decoction, which is nutritive, diuretic and expectorant, and useful in fevers and bronchitis. Powdered root is given for diseases of the spleen and liver, for menorrhagia, debility and fat accumulation. Packed 450mg/cap Warnings: Do not take during pregnancy.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
If you or a family member has signs or symptoms of menorrhagia. if you are experiencing irregular vaginal bleeding, schedule an appointment with your health care provider and be certain to record when the bleeding occurs during the month. If you are having heavy vaginal bleeding - soaking at least one pad or tampon an hour for more than a few hours - seek medical help. Call your health care provider if you have severe menstrual pain that doesn't respond to at-home treatment or if you have vaginal bleeding after menopause.
Symptoms worsen after treatment begins.
New unexplained symptoms develop. Hormones used in therapy treatment, iron supplements, and medications may produce side effects.
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