What Is Menorrhagia

Overview

Menorrhagia is a medical condition characterized by heavy or prolonged menstrual bleeding. The condition can be extremely distressing and disruptive to a woman's life, as reported by approximately 30% of women.

Typically, a woman with menorrhagia will experience bleeding that lasts longer than seven days, and/or an abnormally heavy flow, equal to or greater than 80ml per menstruation. It is the leading cause of gynaecologist checkups.¹

Menorrhagia can have several symptoms, including prolonged menstrual flow, passing of large blood clots, and menstrual cycles that last longer than seven days.

A healthcare provider can diagnose menorrhagia through a combination of medical history, physical examination, and diagnostic tests.

Treatment options for menorrhagia depend on the underlying cause and severity of the condition. Some treatment options include hormonal therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and various procedures, such as endometrial ablation or hysterectomy.

If left untreated, menorrhagia can lead to complications such as anaemia, physical discomfort, emotional distress, and infection.

Causes of menorrhagia

In most cases (40-60%), the cause of this condition is unknown, as it often presents itself with normal ovaries and a normal uterus. This is referred to as dysfunctional uterine bleeding. It is believed to be caused by an imbalance of hormones, notably prostaglandins, which are inflammatory mediators responsible for the thickening and dilation of the uterine blood vessels.

Other causes can be from gynaecological disorders, such as:

• Endometriosis - where people have uterus lining growing in other parts of the body
• Polyps - which are clusters of endometrial cells (which form the lining of the uterus) that block the normal shedding of the womb lining. This can result in abnormal and excessive bleeding
• Uterine fibroids - non-cancerous growth which can also cause excessive and painful menstrual bleeding
• Adenomyosis - a condition where there are growths inside the myometrium (the muscular part of the uterus), causing extreme pain and bleeding during menses²

Other causes are related to hormonal disorders and imbalances, such as polycystic ovarian syndrome (PCOS), obesity, and diabetes, which lead to increased inflammation of the endometrium before menstruation, thus triggering menorrhagia.

It is also important to note that certain medications and contraceptives can cause menorrhagia, such as anticoagulants (medicines to prevent blood clots), blood thinners, or some intrauterine devices. 

Signs and symptoms of menorrhagia

The most common sign of menorrhagia is the soaking of sanitary products every hour or so, for several hours, or having a period lasting more than 7 days. 

Less obvious symptoms include:

• Feeling extremely tired due to blood loss and potential anemia (iron deficiency)
• Passing a blood clot larger than 2.5 cm (around the size of a 10p coin, or a US quarter)
• Heavy periods with extremely painful menstrual cramps

Management and treatment of menorrhagia

The treatment of menorrhagia depends on the underlying cause and severity of the condition. ³ 

This can include:

• Hormonal therapy, such as birth control pills or progesterone therapy
• Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce bleeding
• Intrauterine devices (IUDs) that release hormones or contain copper, however, these can trigger onset menorrhagia before the body gets used to them
• Tranexamic acid which is a drug that reduces blood loss by 30-50%
• Endometrial ablation, which is a procedure to remove the lining of the uterus
• Hysterectomy, which is the surgical removal of the uterus, in severe cases

Other ways to manage this condition are with light exercises such as yoga, and breathing techniques. This could also be beneficial to help with the emotional distress that can come with having the condition. It's important to consult with a healthcare provider to determine the most appropriate treatment option for individual cases of menorrhagia.

Diagnosis of menorrhagia

The diagnosis of menorrhagia typically involves a thorough medical history and physical examination, as well as the following diagnostic tests:

• Blood tests: Taken to evaluate for anemia, thyroid function, and other hormonal imbalances. They are also an opportunity to check for any underlying severity such as uterine cancer
• Imaging tests are useful to check the integrity and functionality of the reproductive organs (ovaries) and the uterus. This is usually in the form of an MRI or Ultrasound during consultation
• The lining of the uterus can be examined with either a biopsy to evaluate for abnormal cells and cancer, or hysteroscopy, a procedure in which a thin, lighted tube is inserted into the uterus to examine the lining

In terms of physical examination, it is performed by a gynaecologist during a consultation and is in the form of a pelvic/bimanual exam.⁴

Risk factors

The most common risk factor is age, with a prevalence higher in women reaching menopause.⁵

As mentioned previously, the other risks are related to conditions that can trigger heavy bleeding, such as:

• Hormonal imbalances caused by endocrine disorders. Hormones are a crucial part of the woman’s cycle and play an imperative role in the levels of prostaglandins. This explains why blood tests are the gold standard method of diagnosis
• Patients with uterine fibroids and polyps are in the highest risk group, as well as with endometriosis and uterine cancer
• Although intrauterine devices such as Mirena Coil help manage the condition,  they can also be a risk right after insertion
• Lastly, blood clotting disorders that would require medication, such as Von Willebrand Disease trigger a blood thinning process, thus accelerating menstrual blood loss

Complications

Menorrhagia can lead to several complications if left untreated. It has a serious impact on the daily life of a woman during menstruation and can cause severe anemia. Anemia is the decrease of iron due to a reduction in red blood cells, causing fatigue and shortness of breath.

Other complications include:

• Reduced quality of life: Menorrhagia can cause discomfort, pain, and anxiety, which can reduce a woman's quality of life. It can also interfere with work, school, and other activities
• Physical discomfort: Heavy menstrual bleeding can cause abdominal cramping, bloating, and inflammation
• Emotional distress: Menorrhagia can be a source of emotional distress, leading to depression, anxiety, and other psychological symptoms
• Infection: In some cases, heavy menstrual bleeding can lead to infection, particularly if tampons or other menstrual products are not changed frequently enough
• Infertility: In rare cases, untreated menorrhagia can lead to infertility, particularly if it is caused by endometriosis or other conditions that affect the reproductive organs

FAQs

How can I prevent menorrhagia?

Menorrhagia is often a symptom of an underlying cause,; there is no guarantee of prevention. However, here are some steps to aid prevention:

• Maintain a healthy weight
• Practice good menstrual hygiene to avoid infections
• Reduce stress - stress can impact your hormonal balance and exacerbate menstrual symptoms, including heavy menstrual bleeding
• Avoid certain medications - certain medications, such as blood thinners, can increase bleeding during menstruation

How common is menorrhagia?

It is estimated that up to 10-30% of menstruating women experience menorrhagia at some point in their lives. The incidence of menorrhagia tends to increase with age, and it is more common among women who are overweight or obese, have a history of pelvic inflammatory disease, or have certain medical conditions such as thyroid dysfunction or bleeding disorders.

Is menorrhagia serious?

Menorrhagia can be serious and impact a woman's quality of life. It is abnormal to have prolonged menstrual bleeding or heavy bleeding; therefore, you should consult with a healthcare provider for appropriate treatment.

How long does menorrhagia last?

The duration of menorrhagia can vary depending on the underlying cause. It may last for a few days longer than a normal menstrual period, or it may persist for several weeks. A healthcare provider can evaluate the individual case and recommend appropriate treatment options to alleviate symptoms and manage the condition.

When should I see a doctor?

You should see a doctor if you experience any of the following with your menstrual bleeding:

• Heavy menstrual bleeding characterized by soaking of sanitary products every 2 hours
• Prolonged menstrual flow (more than 7 days)
• Large volume of blood lost, with the presence of blood clots larger than 2.5 cm (around the size of a 10p coin, or a US quarter)
• Severe menstrual cramps, which result in an incapacity to perform daily tasks

Summary

Menorrhagia is a medical condition characterised by abnormally heavy or prolonged menstrual bleeding. It is a relatively common condition that can have a significant impact on a woman's quality of life. Menorrhagia can be caused by a variety of factors, including hormonal imbalances, uterine fibroids, endometriosis, and certain medications. The condition can be diagnosed through a combination of medical history, physical examination, and diagnostic tests. Treatment options include hormonal therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and various procedures, such as endometrial ablation or hysterectomy.