Menorrhagia
Also found under: Menstrual Disorders
What is it?
The term menstrual disorders refers to any of a number of conditions that are related to the menstrual cycle. Menstruation is the shedding of the lining of the uterus (the endometrium) each month, also referred to as the menstrual period. Menstrual periods usually last for five to seven days. Menorrhagia is the term used to describe menstrual bleeding that lasts more than seven days or bleeding that is much heavier than usual for the individual.
Who gets it?
Any female who has begun menstruating can experience
menorrhagia.
What causes it?
Menorrhagia can be caused by a hormonal imbalance. The start of menstruation during puberty and the length and regularity of the menstrual cycle is controlled by hormones produced in an area of the brain called the hypothalamus, as well as by the pituitary and adrenal glands. The type of hormonal imbalance that causes menorrhagia can occur when hormone medications, such as birth control pills, are used improperly. Other causes of menorrhagia include non-cancerous growths, called polyps, on the cervix or inside the uterus; non-cancerous tumors, called fibroids, on the uterus; a cyst on the ovary; and cancer of the uterus, ovary, or cervix. Menorrhagia can also be caused by miscarriage, a pregnancy that is developing in the fallopian tubes (tubal or ectopic pregnancy), the use of an intrauterine device (IUD) for birth control, or chronic medical problems such as thyroid disorders, diabetes, and blood-clotting disorders.
What are the symptoms?
A woman or teenager with menorrhagia will experience light to heavy bleeding that continues beyond the average seven days of a regular menstrual period. Depending upon the cause, she may or may not have a cramping abdominal pain with the bleeding. Menorrhagia caused by miscarriage or a tubal pregnancy almost always includes cramping, which can be severe.
How is it diagnosed?
To diagnose menorrhagia, your doctor will take a complete medical history, particularly the frequency and length of your menstrual periods. This doctor would most likely be your gynecologist, a doctor who specializes in women's reproductive health. He or she may ask you to keep a calendar of your regular periods and any days of bleeding in between. Your doctor will want to know how heavy the flow is, and if you experience any pain. You will have a physical examination, including a pelvic, or internal, exam. Your doctor may also order blood tests, and may perform some diagnostic tests in the office, depending upon the suspected cause of metrorrhagia. These may include an ultrasound scan, a painless procedure in which a probe is either pressed on your lower abdomen or placed into the vagina. The probe emits sound waves, which bounce off the uterus and produce a picture of the uterus on a monitor. An ultrasound will show a normal or a tubal pregnancy. A sonohysterogram is another type of ultrasound scan in which fluid is injected through a tube into the uterus before the scan is performed. This test gives your doctor a better view of the lining of the uterus. The doctor can also look inside the uterus using a hysteroscope, a small tube with a light that is inserted through the vagina and cervix and into the uterus. Another test called hysterosalpingography involves injecting dye into the uterus and fallopian tubes, through the cervix. When x-rays are taken, the dye outlines the shape and size of the uterus and fallopian tubes. Your doctor may also look for abnormalities in the uterine tissue by removing a tiny sample of tissue from the inside of the uterus, called a biopsy, for examination under a microscope. Two other diagnostic tests used to find the cause of menorrhagia are usually performed in a hospital or outpatient clinic. One is called laparoscopy, in which the doctor makes a small cut in the navel through which he or she inserts a small instrument for examining the uterus and other female organs in the pelvic area. The second procedure, called a dilation and curettage (D & C) involves scraping or suctioning tissue from the lining of the uterus. The tissue is examined for abnormalities in a laboratory.
What is the treatment?
The treatment of menorrhagia depends on the cause of the problem. If a hormonal imbalance is the cause, treatment may include drugs to replace hormones. Or, medications might be used to treat chronic medical problems. If the bleeding is caused by an intrauterine device (IUD), the device may need to be removed. Polyps and other types of growths are treated with surgery. Cancer may be treated with a combination of surgery, radiation, or chemotherapy. Women with bleeding caused by miscarriage or tubal pregnancy need immediate medical treatment because both can cause serious complications if not treated. Dilation and curettage (D& C) may be performed to empty the uterus of any tissue remaining after a miscarriage. In severe cases, menorrhagia is treated with hysterectomy, which is the surgical removal of the uterus, or endometrial ablation, which is the destruction of the lining of the uterus. Both procedures result in sterility, meaning the patient can no longer become pregnant. These procedures are unlikely to be a necessary treatment for girls in their teens.
Self-care tips
Some women have occasional bleeding for longer than seven days. However, let your doctor know if heavy bleeding continues for more than two menstrual periods in a row, especially if the bleeding is accompanied by pain. Once the cause has been diagnosed, be sure to follow the treatment plan prescribed by your doctor.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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