Menorrhagia Treatment

Menorrhagia is defined as the amount of menstruation being more than normal in many consecutive menstrual cycles.

In terms of quantity, the definition of menorrhagia (excessive menstrual bleeding) is the loss of more than 80 ml of blood during each menstrual period.

In practice, total blood loss can rarely be calculated and is more often done by pad calculation.

Menorrhagia can also be described as a condition in which a woman finds her bleeding to be profuse; she has to use more pads during her menstrual cycle than before.

Dysfunctional uterine bleeding is defined as bleeding that is profuse, prolonged or frequent, but for which pregnancy or significant systemic or pelvic disease cannot be ruled out as the cause.

One in 3 women may have heavy menstrual bleeding.

Menorrhagia can occur at any age.

However, it is especially common before menopause.

Every year, one in 20 women between the ages of 30-49 consult a doctor with the complaint of heavy bleeding.

CAUSES OF MENORRHAGIA

Fibroids that occupy space in the uterus (especially submucosal fibroids)

Anovulatory bleeding, e.g. at menarche, perimenopausal period, polycystic ovary syndrome (PCOS)

Endometrial polyp or hyperplasia

Coagulation disorders, e.g. von-Willebrand disease or anticoagulant therapy.

Intrauterine device use (IUD) (spiral)

Thyroid Diseases

Patients usually present with severe bleeding or are referred by another physician for iron deficiency anemia.

If there are clinical signs and symptoms of hypothyroidism, thyroid function tests should be checked.

Coagulation tests should be checked in patients on warfarin or in patients with signs of coagulopathy (easy bruising).

Transvaginal pelvic ultrasound evaluation should be performed to detect fibroids, ovarian cysts and endometrial thickness.

In cases where bleeding cannot be stopped with medical treatment, both diagnosis and treatment can be performed with endometrial biopsy or hysteroscopy.

Treatment

Estrogen or progesterone therapy in case of hormonal imbalance

Myomectomy if fibroids are present,

Removal of endometrial polyps if endometrial polyps are present,

Removal of the IUD if there is bleeding due to the presence of an IUD (spiral)

In patients on warfarin, INR should be regulated as rate correction.