Menorrhagia is the medical term used to refer to heavy menstruation. In a study based on the counting of pads and tampons, it was shown that on average a woman loses 35 ml of blood per menstruation. Menorrhagia is defined as a loss of more than 80 ml of blood (above the 90th percentile).
How often does menorrhagia occur in general practice?
Approximately 5% of women aged 30-49 seek help from their general practitioner because of heavy bleeding. Therefore, menorrhagia is a condition that the general practitioner should be able to effectively treat. This is also important because until recently the risk of removal of the uterus (primarily due to menstrual disorders) at reproductive age was 20%.
What should women know about menorrhagia and how can a doctor help them?
Recently, an interesting study was conducted on how women themselves perceive menorrhagia, how they understand the mechanism of its occurrence and what kind of help they expect from health workers. Evaluated the results of a survey of women who applied to their general practitioner about the "heavy periods". The researchers found that women understand their symptoms quite specifically. The change of the cycle itself was already regarded by many women as a problem, without additional criteria. Women paid particular attention to how they feel, how efficient they are, but without enthusiasm they perceived the doctor's proposal to measure the amount of blood loss. Many of the women were disappointed with the advice of the general practitioner and felt that he had missed the crux of their problems. Women looked for explanations of the reasons for the change in their cycle and did not fully understand what constitutes menstrual bleeding. The respondents were not sure whether their problem should be considered a disease or what level of discomfort should be considered normal.
A physician should consider blood loss to be excessive in case it reduces the physical, emotional, social and material quality of life, regardless of the presence of other symptoms. Accordingly, any interventions should be aimed at improving the quality of life.
What is the doctor’s tactic for a woman complaining of heavy menstruation?
In the last evidence-based manual, a new approach to the treatment of severe blood loss during menstruation in general practice was proposed.
This algorithm assumes that the general practitioner as a first step:
- suggest the nature of the bleeding,
- evaluate symptoms that may indicate anatomical or histological abnormalities,
- assess the impact on the quality of life, as well as other factors that can determine therapy (for example, the presence of comorbidities).
What are the key points that need to be clarified when taking a history of a patient complaining of heavy menstruation?
The first step is to determine the degree of blood loss. It can be difficult for women to measure it. Instead of measuring blood loss by counting the pads, the general practitioner can identify “indicators” by asking the following questions:
- How many tampons or pads do you use per day?
- Do you have blood clots?
- Did you have to use both a tampon and a gasket and still worry about the possibility of leakage?
- Did you have a feeling that blood is being released in a continuous stream?
Blood clots, the sensation of blood flow and the need to use pads and tampons at the same time are good indicators of menorrhagia.
After that, it is important to find out how much bleeding is regular. This will tell if the bleeding is due to an ovulatory or anovulatory cycle in which dysfunctional uterine bleeding could occur. In women aged 36-50 years, heavy menstruation usually occurs on the background of the ovulatory cycle and is caused by myomatous nodes. 80-90% of women with severe menstrual bleeding have regular cycles (lasting 21-35 days). In women with prolonged irregular or intermenstrual bleeding, in 25-50% of cases there are submucosal myomatous nodes or endometrial polyps (the evaluation was carried out in carefully selected patients). The frequency of sub-mucous nodules and polyps in women with regular heavy menstruation is unknown.
Irregular and intermenstrual bleeding unlike regular ones often indicate the presence of pathological changes.
Very rarely, bleeding disorders may be the cause of menorrhagia. Nevertheless, laboratory studies have shown that women with menorrhagia have increased fibrinolytic activity and increased production of prostaglandins in the endometrium. These observations were the basis for the introduction of some new approaches to the treatment of menorrhagia.
In the third stage, you should find out how the symptoms affect the ordinary life of a woman. Does she cope with work, family life and daily chores during her period? Does she have to constantly ensure that there is a toilet or bathroom nearby that she has to visit due to bleeding? Answers to these questions will allow the general practitioner to understand how urgent the situation is.
Ultimately, the general practitioner must assess the likelihood of anemia. In Western countries, menorrhagia is the main cause of iron deficiency and anemia. Therefore, a decrease in hemoglobin concentration objectively reflects the severity of blood loss during menstruation.
What data history allows the doctor to suspect the presence of pathology?
Structural abnormalities of the uterus, such as endometrial polyps, adenomyosis and leiomyomatosis, are the most well-known causes of excessive uterine bleeding. The physician should be alert to the history of evidence indicating the presence of organic pathology and malignant tumors, and remember that the risk of endometrial cancer begins to increase after 40 years.
Risk factors for endometrial hyperplasia in premenopause include:
- infertility or lack of pregnancy
- exposure to an excess of endogenous estrogen or exogenous estrogen / tamoxifen,
- the presence in the family of cases of endometrial cancer or colon.
The risk of hyperplasia and endometrial cancer with heavy menstrual bleeding is:
- 4.9% for all women
- 2.3% in women younger than 45 years old and weighing less than 90 kg,
- 13% in women weighing more than 90 kg,
- 8% in women over 45 years old.
If a woman has a history of no indication of the risk of anatomical or histological pathology, then already during the first visit, you can prescribe medication without the need for physical or other examinations. An exception would be the installation of an LP-IUD or a scheduled smear from the cervix on a Papanicolaou. If a history of an indication of heavy menstrual bleeding in combination with intermenstrual or post-coital bleeding, pelvic pain, dyspareunia and / or stress symptoms, a physical examination and / or other studies (eg, ultrasound) are necessary to exclude malignant neoplasms and other pathology .
When should a doctor do an examination?
Many, recalling the old adage “what you don’t look for, you won’t find it,” recommend gynecological examinations for all women with menorrhagia.
The NICE manual states that inspection is necessary in the event of:
- if the general practitioner believes that there is an indication in the history of a possible pathology,
- if the woman decided to install the LV-IUS (examination is necessary to assess the possibility of placing the helix in the uterus),
- if the woman is sent for further examination, such as an ultrasound scan or biopsy.
If a woman’s myomatous nodes are palpable through the abdominal wall, or are detected in the uterus during ultrasound or hysteroscopy, and / or the length of the uterus is more than 12 cm, it should be immediately sent to a specialist for consultation.
What laboratory tests should the doctor prescribe for a woman with menorrhagia?
Since there are many different research methods, one should be thoughtful about their purpose and remember that 40-60% of women will not find the cause of menorrhagia (in such cases, uterine bleeding is regarded as dysfunctional (unexplained etiology)).
Clinical manifestations of anemia do not correlate with hemoglobin levels, with the exception of moderately severe and severe cases. Therefore, for all women with heavy menstruation, a complete blood count should be performed to further assess the severity of blood loss. Routine determination of iron levels is not recommended, since hematological indices, as a rule, provide a good idea of the state of iron reserves. In women with severe anemia, the likelihood of pathology is increased, and they should be immediately referred to a specialist. Tests for coagulopathy should be carried out only in cases where heavy menstruation affects a woman from the time of menarche, as well as if there were cases of coagulation disorders in personal or family history. To assess the level of female hormones is not justified. The study of the level of thyroid hormones is shown only in the presence of signs of thyroid disease.
Recommendations for the most common laboratory tests for menorrhagia
- All women with menorrhagia should be given a complete blood count. In parallel, treatment of menorrhagia should be prescribed.
- Screening for coagulopathy (for example, Willebrand disease) should be given to women with menorrhagia, observed since the time of menarche, as well as if there were cases of coagulation disorders in the personal or family history.
- Measuring serum ferritin levels should not be routinely prescribed to all women with menorrhagia.
- Women with menorrhagia should not be assigned to study the level of female sex hormones.
- The study of the level of thyroid hormones is shown only in the presence of signs of thyroid disease.
- In the case of menorrhagia, serum ferritin level does not provide more information than can be obtained from a general blood test.
What is the role of ultrasound in the examination of women with heavy bleeding?
Convincing evidence was obtained in favor of ultrasound as the primary method for detecting structural anomalies. This is a non-invasive and painless method of choice for women who need additional testing. Using ultrasound, it is possible to determine the thickness of the endometrium (in premenopausal women, the normal limit is 10-12 mm), to identify polyps and nodes.
Convincing evidence has been obtained in favor of using transvaginal ultrasound as the primary diagnostic method for examining women with menorrhagia.
This survey should be carried out in the case of:
- if the uterus is palpable through the abdominal wall,
- if during vaginal examination revealed education in the pelvic cavity of unknown origin,
- if drug treatment is ineffective.
What is the role of hysteroscopy and biopsy?
Hysteroscopy as a diagnostic procedure should be carried out only with the ambiguity of the conclusion of ultrasound, for example to accurately determine the location of myoma node or clarify the nature of the detected anomalies.
Biopsy is needed to rule out endometrial cancer or atypical hyperplasia. Indications for biopsy are:
- stoic intermenstrual bleeding,
- the disappearance or initial lack of effect of treatment in women 45 years and older.
Do not use as a diagnosis only curettage of the uterus.
Which women should be referred for endometrial testing?
It is not completely clear which women should be referred to endometrial research and what kind of research should be. A guide from New Zealand recommends transvaginal endometrial ultrasound to the following women:
- weighing more than 90 kg
- over the age of 45 years (according to the English manual, it is recommended to conduct an additional examination after 40 years)
- with other risk factors for endometrial hyperplasia or cancer, such as an established diagnosis of PCOS, infertility, zero parity of pregnancies, exposure to excess estrogens, or familial cases of endometrial or colon cancer.
If, for transvaginal ultrasound, the thickness of the endometrium is more than 12 mm, a sample of the endometrium should be taken to exclude hyperplasia. If there is no transvaginal ultrasound data, then a sample of the endometrium should also be taken. Women with irregular menstrual bleeding, lack of results from drug therapy and signs of pathology with transvaginal ultrasound (polyps or submucosal myomatous nodes) show hysteroscopy and biopsy. As a diagnostic procedure, hysteroscopy and biopsy are more informative. An alternative to a biopsy is endometrial aspiration biopsy. The procedure is performed blindly, and, despite the greater comfort for the woman, it remains controversial whether she can replace hysteroscopy with a sufficient level of sensitivity and specificity.
Endometrial thickness greater than 12 mm may indicate hyperplasia.
Should all women with menorrhagia be prescribed iron tablets?
During normal menstruation, bleeding lasts 4 ± 2 days, during which 35-40 ml of blood is lost on average - an amount equivalent to 16 mg of iron. The recommended use of iron with food is enough to compensate for 80 ml of blood loss per month. However, the average woman consumes insufficient iron with food, which leads to the fact that anemia can develop with the loss of 60 ml of blood per month. In most cases, the main symptom that bothers women with severe uterine bleeding is weakness due to anemia. For the treatment of anemia, 60-180 mg of elemental iron should be consumed per day.
What treatment can a general practitioner prescribe for women with menorrhagia?
Drug treatment is prescribed if there are no signs of anatomical or histological pathology or there are myomatous nodes less than 3 cm in diameter that do not cause expansion of the uterine cavity.
As was shown in the clinical case, the general practitioner must prescribe a woman any treatment aimed at reducing blood loss, before, if necessary, she will be examined by a gynecologist. There are many tools available to the general practitioner, including NSAIDs, hormone therapy (COC or cyclic administration of gestagens), tranexamic acid, and even Mirena - LV-IUD. If drug treatment is prescribed for the duration of the study and the organization of radical treatment, tranexamic acid and NSAIDs should be used.
Drug therapy for menorrhagia is very effective and should be used by a general practitioner.
There are several factors that influence the choice of therapy:
- the presence of ovulatory or anovulatory cycles,
- the need for contraception or the desire to get pregnant,
- patient's preference (in particular, how satisfied she is with the use of hormone therapy),
- contraindications to therapy.
If, based on the history and examination results, drug hormonal or non-hormonal therapy is indicated, it should be prescribed in the following order:
- preferably long-term (at least 12 months) use of the LP-Naval Forces,
- Tranexamic acid, NSAIDs or COCs,
- norethisterone or long-acting injection progestogens.
Danazol should not be used routinely for the treatment of heavy menstrual bleeding.
Types of menorrhagia and their manifestations
Menstruation, lasting more than a week and forcing to change hygienic means every hour or two or more, are in 30% of women. This is a group of different age. In accordance with this, the syndrome is divided into species. Although menorrhagia ICB is united under the common code number 92.0.
Monthly sometimes from adolescence is characterized by a large number of discharge and duration. For some, this happens with menarche, others find the syndrome when menstruation comes in the second and subsequent times. Such menorrhagia (mkb code 92.2) is referred to as “Abundant menstruation in the puberty period”.
For young age is characterized by hormonal instability. The amount of estrogen can significantly exceed the norm throughout the cycle, and progestins are in short supply. This is the reason for the diagnosis of "primary menorrhagia." The excess of one and the lack of other substances lead to the preservation of the thickness of the endometrium in the second phase of the cycle. When it begins to be torn away, there are a lot of replaced tissues, as well as capillaries and blood. The development of the mucous membrane is uneven, so its detachment lasts a long time. If there is underdevelopment of the uterus, menorrhagia also contributes to its low ability to contract.
Not only teenagers suffer from heavy and long periods. And in adult girls, women after many normal cycles, idiopathic menorrhagia can occur. Она обусловлена появлением нарушений развития слизистой матки, вызванных разными причинами. Этот вид болезненного синдрома является вторичным.
How to distinguish just abundant periods from a pathological condition? Menorrhagia symptoms manifest bright, they are easy to identify:
- The process takes more than a week
- discharges are distinguished by a large volume, the presence of clots, they remain so for the whole period of menstruation, at night,
- the amount of lost blood exceeds 150 ml, and the used pads per day - more than 10 pieces,
- there is a strong weakness, a little letting go after the cessation of bleeding,
- the cycle is reduced in time.
The excretions found in the syndrome are precisely menstrual, that is, they occur on schedule and after the breakdown of an unfertilized egg. Do not confuse the concepts of menorrhagia and metrorrhagia. The latter means intense discharge, not related to the maturation of the germ cell. However, both syndromes are often combined.
The causes of the pathological phenomenon
What is the reason for the emergence of hyperpolymenorrhea, depends in some cases on its type. Infections and stresses have a strong effect on the body of adolescents, making primary pathology more affordable. The same can be with hereditary problems with blood clotting and genetically determined features of menstruation, when the mother and grandmother of the girl had the same problem. But in general, menorrhagia causes are wider:
- Periods of hormonal changes. This, of course, is about teenagers, but also about women who have recently survived childbirth, as well as those who are on the verge of menopause. In the latter case, the ICD encrypts pathology under the code No. 92.4.
- Use of intrauterine contraception. Spiral, candles can have a side effect.
- Endocrine pathologies, diseases of the liver, kidneys, cardiac problems. All affect the hormonal status.
- Pathology of the reproductive system. This cause of the syndrome unites polyps, adenomyosis, and ovarian diseases. If uterine fibroids are diagnosed, menorrhagia can also be combined with metrorrhagia.
- Hard physical labor, frequent changes in climatic conditions. All this is a serious test for the body.
- Improper use of drugs or the period of adaptation to them. These can be hormones and blood-thinning agents.
The emergence of the NMC in the type of menorrhagia should convince a woman to go to a specialist. He will find out the circumstances after which the syndrome was discovered, examine the patient on the chair. If this is not enough, the following are shown to establish the cause:
- Pelvic ultrasound,
- curettage and examination of the organ mucosa,
- laboratory blood tests for biochemistry and hormones, coagulogram, detection of tumor markers CA 19-9, CA-125,
- cytological examination of cervical tissue.
Treatment of menorrhagia
The restoration of normal menstruation is done mainly by conservative methods, which include:
- The use of reducing blood loss and contributing to its reimbursement. These are “Ditsinon”, “Tranexam”, aminocaproic acid, “Vikasol”. You will need and vitamins: K, askorbinka, "Askorutin."
- Hormonal treatment. It can be low-dose COC "Marvelon", "Logest", which take 3 - 6 months. For some women, the use of the Mirena Navy, which directly affects the amount of endometrial tissue, is best. Simultaneously with the hormones, they drink the B vitamins in the first part of the cycle and A, C, E - in the second.
- Acceptance of non-steroidal anti-inflammatory drugs "Ibuprofen", "Naproxen", "Indometacin". They are drunk all the time menstruation, drugs reduce discharge.
Possible and radical method of intervention - surgical. It is held for patients who have a relapse of the disease, iron deficiency anemia, or there are physiological disorders, damage to the genitals.
We recommend reading the article on the use of the drug Vikasol for menstruation. From it you will learn about the effect of the drug, its purpose, the restoration of normal discharge with the help of Vikasol.
Menorrhagia treatment with folk remedies also allows, if it is agreed with the doctor. Bleeding will die and give strength:
- Nettle juice Need to drink a teaspoon three times a day.
- Infusion of 2 tbsp. l., taken equally with the shepherd's bag and white mistletoe 400 ml of boiling water. Prepare him an hour, drink a glass in the morning and evening.
Menorrhagia in women is not a disease, but a sign of a problem. You do not need to be a hero, suffering in silence, or try to cope on your own. You should find out the cause of the syndrome and deal with the problem, based on a thorough diagnosis.
Recommendations for the appointment of drug therapy abundant menstrual bleeding
- Women for whom it is planned to install LV-IUD should be warned about the possibility of changing the nature of bleeding, often in the first few cycles, sometimes lasting more than 6 months. They should suffer at least 6 cycles in order to evaluate the beneficial effect of treatment.
- When profuse uterine bleeding is combined with dysmenorrhea, NSAIDs are preferable as therapy with tranexamic acid.
- The use of NSAIDs and / or tranexamic acid should continue as long as the woman feels the benefits of them.
- Use of NSAIDs and / or tranexamic acid should be discontinued if there is no improvement during the three menstrual cycles.
- If the initial therapy was ineffective, instead of sending an immediate referral for surgical treatment, the possibility of a second-line appointment should be considered.
- Progestogens administered orally only in the luteal phase of the cycle should not be used for treatment of heavy menstrual bleeding.
The two main first-line therapies for menorrhagia - antifibrinolytic tranexamic acid (cyclokapron) and NSAIDs - non-hormonal. The effectiveness of these drugs has been proven in randomized trials and systematic reviews.
Women who are not planning a pregnancy and who can be given medical therapy as their first choice can recommend the installation of the LV-IUD.
For ease of understanding, a general practitioner can tell his patients that tranexamic acid reduces blood loss during menstruation by half, and NSAIDs by about a third. For most women with whom the general practitioner deals, such an explanation will give hope that they will be able to return to their “normal” menstruation, and the need for surgery will disappear. Both types of drugs have the advantage of taking only during menstruation (which contributes to better adherence), and are particularly suitable for women who do not need contraception and do not want to take hormone therapy. These types of therapy are also effective for enhanced menstrual bleeding while using non-hormonal intrauterine contraceptive devices.
What is the mechanism of action of tranexamic acid, its side effects and contraindications to the appointment?
Tranexamic acid inhibits plasminogen activation and inhibits blood fibrinolytic activity. Reviews have shown that the proper use of tranexamic acid (taking with the onset of bleeding) for 2-3 cycles reduced menstrual blood loss by 34–59%. Adverse events, such as nausea, vomiting, diarrhea and dyspepsia, were observed in 12% of women. Unlike NSAIDs, tranexamic acid had no effect on dysmenorrhea. Contraindications include venous thromboembolism or a history of stroke, acquired violation of color vision.
It is also important to note that tranexamic acid:
- does not affect the dysmenorrhea / pain associated with bleeding, therefore, may require additional prescription pain relief,
- does not have a contraceptive effect, so additional contraception may be required,
- does not regulate the menstrual cycle, therefore, if necessary, additional counseling and treatment may be required.
How should NSAID be prescribed to treat menorrhagia?
You can use any NSAIDs, but most often are prescribed:
- mefenamic acid (Ponstan),
- diclofenac (Voltaren),
- naproxen (naprosyn).
A woman should take pills only during menstruation. For dysmenorrhea, for maximum efficiency, you should try to start taking it when menstruation should begin. A general practitioner should be careful about contraindications to NSAIDs. These include:
- continued gastrointestinal bleeding or the presence of ulcers,
- inflammatory bowel disease,
- history of hypersensitivity (asthma, angioedema) caused by aspirin or NSAIDs,
- impaired renal or hepatic function.
How useful is hormone therapy?
Traditionally, hormone therapy for menorrhagia has been to use progestogens administered in the luteal phase of the cycle. Progestogens effectively reduce blood loss only if they are prescribed for 21 days of each cycle. However, the complications of such therapy may lead to the fact that patients refuse to continue it.
COC therapy may be more familiar to the general practitioner. In the absence of contraindications, the administration of COCs produces a beneficial effect in menorrhagia. In addition to providing contraception, drugs significantly reduce the amount of blood lost during menstruation. A general practitioner can choose the most appropriate pills for a woman. For example, if levonorgestrel has not sufficiently reduced bleeding, you can try a drug that contains norethisterone, or third-generation progestin-based contraceptives. The doctor may also suggest that the woman skip the pacifiers in the package and drink hormonal pills continuously - this will give a good rest from menstruation. COCs are also effective in anovulatory bleeding because they regulate the cycle.
The preferred and final method of therapy due to its economic feasibility with long-term use is the LP-IUD (Mirena). It is a T-shaped base, covered with a reservoir of levonorgestrel, released at a rate of 20 mg per day. Due to this low level of hormones, the systemic side effects of gestagens are minimized. Therefore, patients are more likely to continue this therapy than cyclic progestogen administration. IUD has its effect by reducing the proliferation of the endometrium and, as a consequence, reducing the duration and severity of bleeding. Up to six months and, especially, in the first three months after the installation of the system, irregular bleeding and scarce bleeding may disturb the patient, but by 12 months. most still have only minor bleeding or amenorrhea develops. Many of the problems associated with bleeding and scarce bleeding can be overcome with careful preliminary counseling.
What are the principles of surgical treatment?
Drug treatment of menorrhagia in no way excludes the possibility of surgical intervention as the next step. In this case, a conservative approach can give a woman time to recover from “heavy menstruation” and consider all possible options for further treatment, including prompt. If drug treatment has not been applied, then the woman may decide that the surgery is the only way out of the difficult situation in which she finds herself. For many women, the removal of the uterus is in fact the best choice, meaning the cessation of the need for treatment of menorrhagia.
Menorrhagia - what is it?
Most women, having heard this diagnosis in the doctor’s office, panic. Do not do this. Menorrhagia is menstruation, which has a slightly different character. Experts describe this concept as abundant or long periods. Some women suffering from this pathology, believe that this is only an individual feature of the body. However, doctors find the cause of the disease in almost all patients who have asked for help with such complaints.
Menorrhagia - what is it? This is the discharge of blood from the genital tract, which occur in a timely manner and correspond to the cycle. However, their number is much larger, and the duration exceeds one week.
Signs of menorrhagia
What is menorrhagia in women can be easily understood by its symptoms. If you find yourself in one or more signs, then it is necessary as soon as possible to consult a gynecologist. Otherwise, the condition of the representative of the weaker sex can greatly deteriorate. The symptoms of pathology are the following:
- menstruation lasting more than seven days (usually up to 10 days)
- discharge, in which there are clots,
- pain in the lower part of the peritoneum and lower back during menstruation,
- the secreted blood has a bright scarlet or brown hue,
- decrease in hemoglobin during menstruation,
- deterioration of general well-being and decreased performance
- the need to change the pad or tampon every two hours.
Pathology diagnosis is carried out by laboratory methods. A woman is assigned some tests and studies of the state of the reproductive organs and the level of hormones.
Causes of pathology and its treatment
Depending on what causes the menorrhagia, the appropriate correction of this condition is chosen. Treatment should be administered only after a preliminary examination and consultation with a doctor. Any independent intervention may be wrong and only aggravate this process.
Menorrhagia treatment may be different. In most cases, the patient is assisted by conservative therapy. However, there are situations when surgery is necessary. Consider the main causes of menorrhagia and how to treat it.
Among the causes are pathologies such as adenomyosis, endometrial hyperplasia and endometriosis. They arise because of an excess of estrogen in the body of a woman. In this case, discharge is often accompanied by severe discomfort. Most women with these diseases suffer from prolonged infertility. All due to improper secretion of hormones and the proliferation of the mucous layer of the uterus.
The treatment of such a pathology in most cases is hormonal. Drugs such as Duphaston, Utrozhestan, Zoladex, Buserelin are prescribed. Any oral contraceptive pill can also be used. Only in especially neglected situations surgical interventions may be needed. Most often it is laparoscopy, curettage of the reproductive organ cavity and hysteroscopy.
Disruption of the circulatory system
In some cases, heavy periods can be caused by poor blood clotting. In this case, the woman not only suffers from heavy and prolonged discharge, but also notes severe bleeding when receiving any injury.
The treatment in this case is always selected individually. Often, women are assigned such compositions as "Tranexam", "Ditsinon", "Water pepper" and so on. It is worth noting that some drugs can not be taken regularly. Others are allowed to use only from the second or third day of the menstrual cycle.
Another cause of menorrhagia can be a benign or malignant tumor. Most often, patients are faced with the first type of neoplasm. However, they may be in the form of myomas or cysts located on the ovaries.
Treatment in such situations is most often surgical. Under general or epidural anesthesia, the surgeon removes the pathological formation and sends it for histological examination. Only after this additional correction may be recommended.
Sometimes the cause of prolonged periods may be incorrectly chosen contraception. Often it is oral hormones and intrauterine devices. If the cause of the pathology lies precisely in this, then the symptoms of menorrhagia occur immediately after the onset of such protection from pregnancy.
Treatment in such cases is symptomatic. Doctors recommend immediately stop using the selected funds and consult a doctor. Doctors will find you suitable drugs that will not cause such manifestations.
Abundant periods can occur due to improper behavior of women. If the representative of the weaker sex is engaged in professional sports, then at the time of menstruation you need to stop training. Otherwise, such an impact can lead not only to abundant secretions, but also cause many health problems.
A variety of diets can trigger menorrhagia. A woman during menstruation and throughout the cycle should eat fully and get the necessary proteins, carbohydrates and fats. If this does not occur for a long time, then dysfunctional bleeding often occurs.
Summary of the article
You now become aware of such a thing as menorrhagia. What is it - described above. If you suffer from these symptoms, then you should contact a medical institution. Independently identify the cause of the pathology and its treatment is almost impossible. Только гинеколог сможет правильно поставить диагноз и назначить подходящую коррекцию. Зачастую лечение требует госпитализации в стационар. Никогда не отказывайтесь от подобного предложения.Long-term lack of treatment can lead to complications. In severe cases, complete removal of the uterus is required. Health to you!
Symptoms of the disease
Prolonged and heavy uterine bleeding (menorrhagia) recur at regular intervals. Symptoms of menorrhagia can serve the following indicators: in normal menstruation lasts from three to five days, while blood loss does not exceed two hundred milliliters. When menorrhagia, this period is delayed for a week or more, blood loss can reach five hundred milliliters.
Menstrual flow is not only blood, but a biological fluid that has a mixed composition. But, nevertheless, its great loss transforms the optimal cycle into a serious violation. Possible development of iron deficiency anemia, which provokes sudden syncope and poses a threat to health. Due to heavy discharge during menstruation, the woman is forced to change the sanitary pad every hour.
Often, menorrhagia is accompanied by bruises on the body, bleeding from the gums and nose.
Menorrhagia should be considered a serious cause for concern, which signals many disorders, and even means the development of any pathologies in the reproductive system.
Causes of menorrhagia can be:
- Hormonal imbalance, when in different phases of the cycle violated the correct ratio of sex hormones.
- General hormonal disorders in the body (in the work of the thyroid gland, ovaries).
- Use of intrauterine device (contraceptive).
- Hormonal adolescent imbalance.
- Contraceptive use.
- Diseases of the kidneys, liver, cardiovascular system.
- Menorrhagia is accompanied by uterine myomas, fibromyoma, chronic endometritis, endometrial polyps, uterine cervix, uterine cavity, endometriosis, adenomyosis, and other diseases of the reproductive system.
- Blood clotting disorders, anticoagulants.
- Diseases - hemophilia, thrombocytopathy, vitamin K deficiency.
- Menorrhagia is characteristic of ectopic pregnancy.
- Sharp climate change (travel to hot lands).
- Psycho-emotional and physical stress, stress.
Therapy depends directly on the cause of the disease. Also, treatment is determined by the duration and profusion of bleeding.
For the regulation of hormonal balance, hormonal contraceptives are prescribed, which normalize the ratio of progesterone and estrogen. Menstrual flow is reduced by about 40%.
Iron preparations are prescribed to prevent anemia. Blood loss helps reduce rutin, combined with ascorbic acid. Anti-inflammatory drugs are often prescribed, for example, Ibuprofen. To correct severe bleeding, it is necessary to apply hemostatic agents: chloride, calcium gluconate, "Ditsinon", aminocaproic acid.
Treatment of menorrhagia can also be carried out by physiotherapy (applications with ozokerite, diathermy).
In some cases, the treatment of menorrhagia necessitates surgical intervention (uterine cavity, cervical canal is scraped, endometrial polyps, fibroids are removed).
Indications for surgical treatment are:
- Damage as well as physiological disorders of the genital organs.
- Recurrent menorrhagia.
- Iron-deficiency anemia.
- Drug therapy did not give the desired effect.
- Surgical treatment of menorrhagia causes mixed reviews. But in most cases this allows the patient to gain health and forget about this ailment.
Surgical procedures are divided into two types: hysterectomy and hysteroscopy.
Menorrhagia (what it is, we found out) is treated in such a surgical way as hysterectomy is the removal of the uterus, which is carried out through the vagina or a small incision in the abdominal cavity. This type of surgical intervention is extremely rare for young women, only in exceptional cases, since it is impossible to get pregnant after hysterectomy.
This operation, according to patients, brings significant relief, sexual desire does not decrease, sex life remains at the same level, and even becomes brighter. The advantages of the operation include the fact that the patient's body recovers very quickly (within a few days), there are no significant surgical scars. From the practice of hysterectomy, it can be concluded that in most cases the cycle after surgery interrupts, the discharge is no longer disturbing, with time comes the menopause.
During hysteroscopy, the walls of the uterus are examined with the help of a special instrument that is equipped with an optical system. The procedure allows for diagnosis and at the same time eliminate any violations. A hysteroscopy procedure is carried out in a hospital or on an outpatient basis. The effectiveness of the operation is up to 85%. Before the intervention, the patient determines the Rh factor and blood type, takes a gynecological smear, as well as tests for hepatitis B and syphilis.
Complications and consequences
Menorrhagia leads to various disorders in the reproductive system that it is necessary for any woman to know. Having found at least some symptoms of the disease, you should immediately contact a gynecologist. Late intervention and delayed elimination of the causes of menorrhagia can lead to:
- the development of anemia,
- the emergence and further development of malignant tumors of the reproductive system,
- significant deterioration in the quality of life, possible disability.
If a woman is regularly examined by a gynecologist (once every six months), then the problems identified in time and the correctly prescribed treatment will protect her from such a disease as menorrhagia.
Menorrhagia - what is it and is it possible to alleviate the symptoms of the disease by popular methods? In some cases, yes, you can resort to grandmothers' recipes to alleviate the condition, but it is necessary to treat the causes of the disease only under the supervision of a doctor.
Tincture of fezalis gives a positive effect. She prepares in advance. It is necessary in the half liter of vodka to insist dried fezalis roots (50 g). The medication is infused for two weeks, the contents need to be shaken periodically. You need to take 20-30 drops before meals three times a day.
Take the dry leaves of raspberry, chop, pour three tablespoons of boiling water (half a liter). Infused medication up to six hours in wrapped form. Four times a day, you need to drink a decoction in the form of heat for half a glass.
Make a collection, it will include: leaves of white amela, blackberries, grass, shepherd's bag. You need to take 50 grams of collection, a liter of dry red wine, mix. After five hours, bring the mixture to a boil. Next, all you need to cool and then strain. The tool must be taken three times a day, 50 ml.
In any case, for menorrhagia, be sure to contact your gynecologist for help. The human body is a complex system, each individual. It may be that the funds that have helped one can harm the other. Only a doctor with the help of correct diagnostic methods is able to accurately identify the cause of the disease and prescribe the correct treatment.
In the prevention of menorrhagia includes a number of the most simple rules, the observance of which gives a chance to avoid this insidious disease, this includes:
- Full and timely treatment of various infections, inflammations of the pelvic organs.
- Constantly keep a menstrual calendar that allows you to track the regularity of the cycle, the duration and the abundance of secretions.
- If possible, exclude from the life of psycho-emotional and intense physical exertion, overwork, as well as abrupt climate change.
- Give up bad habits.
- Maintain a healthy lifestyle (proper nutrition, exercise).
- Observe personal hygiene.
- Visit the gynecologist twice a year for a periodic examination.
Menorrhagia in adolescents
What is this menorrhagia in women, it is now clear, the question arises - at what age can the disease manifest itself? The practice of gynecologists shows that already in adolescence, menorrhagia can cause disruption of the normal course of life. Girls aged 13-16 complain of prolonged and heavy bleeding, cycle violations. At the reception, the doctor, first of all, pays attention to height, weight, the formation of sexual characteristics, excludes diseases that inhibit development. The general state of health (attendance at sports activities, work capacity, activity during menstruation) also indicates a certain predisposition to gynecological diseases. In a conversation with adolescents, the doctor must explain that nothing terrible happens in the body, and qualified treatment will help fix the situation in a short time.
Diagnosis in adolescents
In addition, the girl undergoes a primary examination by a gynecologist, during menorrhagia, she is sent for a blood test for hemoglobin. The doctor must find out if there are signs of iron deficiency anemia. If the value is too low, in some cases the gynecologist recommends hospitalization with a blood transfusion procedure. This safe measure is very effective in menorrhagia during adolescence. The doctor also recommends the girl to keep the menstrual calendar under the guidance of her mother or sister, to clearly mark the days, duration and abundance of discharge.
Treatment of menorrhagia in girls
The treatment of menorrhagia largely depends on the fact whether there is heavy bleeding for the first time or whether it is a regular occurrence. In the primary case, the girl is prescribed to take certain oral contraceptives several times a day during the week. A side effect can be nausea. Another option is alternative means that normalize the cycle and cause menstrual-like bleeding. Drugs should be taken 12 days a month for six months (six cycles).
With regular menorrhagia, special drugs are prescribed that affect the uterine lining, reduce the amount of secretions. Such funds are used only during menstruation.
The effect of treating menorrhagia during adolescence generally appears after six months, when the cycle is restored. The patient should be examined regularly by her gynecologist.
Causes and risk factors
The exact cause of menorrhagia is unknown, but an imbalance in the amount of female hormones, progesterone and estrogen, plays an important role. The most common causes and risk factors for the development of this condition are:
Hormonal imbalance. The hormones estrogen and progesterone regulate the menstrual cycle in women and are responsible for thickening the inner lining of the uterus (endometrium). An imbalance of these hormones can lead to excessive thickening of the endometrium and more severe bleeding.
- Age. Girls in the period of the first menstruation and women approaching menopause (at the age of 40–50 years) have irregular menstrual cycles without ovulation. It directly reduces the amount of the hormone progesterone and causes heavy bleeding during menstruation.
- Uterine tumors. Benign outgrowths on the uterus, such as polyps and fibroids, which appear in women of reproductive age, can cause heavy menstrual bleeding.
- Complications during pregnancy. Miscarriage or ectopic pregnancy can also cause hypermenorrhea.
Intrauterine device. The IUD is a small contraceptive device that is inserted into the uterus. Severe uterine bleeding can be a side effect of an IUD.
- Coagulability disorders. Von Willebrand disease or platelet dysfunction are genetic diseases. In this case, there are no specific proteins in the blood that are necessary for blood coagulation.
- Other disorders. Inflammatory diseases of the pelvic organs, liver, kidney or thyroid, as well as endometriosis can increase the risk of menorrhagia in women.
- Medication. The use of certain anti-inflammatory drugs and anticoagulants can lead to an increase in the profusion of menstruation.
It happens that hypermenorrhea develops due to a combination of several factors.
Symptoms of pathology
Women with this disease suffer from bleeding, which lasts more than 7 days at a rate of 4-5, and lose more than 80 ml of blood per day. The need to change hygienic protection almost every hour can be a key diagnostic sign of menorrhagia.
If you have the following symptoms, you should immediately consult a doctor:
soaking several sanitary pads or tampons per hour,
- the need to use two gaskets simultaneously,
- waking up at night to replace a pad or tampon,
- prolonged bleeding, which is observed for more than a week,
- the presence of large blood clots in the discharge,
- inability to engage in daily activities
- constant fatigue and general weakness (as signs of anemia).
The main reason for going to a doctor is discomfort in women who suffer from excessively heavy periods. In addition, often severe bleeding is accompanied by pain.
Classification and Diagnosis
Before you diagnose a disease, you should determine the exact terminology. Depending on the clinical picture, the following types of similar conditions are distinguished:
- NMCs of the type of menorrhagia are the same as hypermenorrhea - prolonged and heavy uterine bleeding with the preserved rhythm of menstruation. They are diagnosed with a duration of more than 7 days and blood loss above 80 ml. Ovulation occurs in such cases.
- Polymenorrhea - bleeding that occur on the background of a steadily shortened menstrual cycle. Menstruation in this case lasts less than 21 days and is usually accompanied by infertility.
- Metrorrhagia, or menometrorrhagia - uterine bleeding, not characterized by the presence of rhythm. They often occur after a long absence of menstruation or oligomenorrhea.
In modern medicine, for the diagnosis of menorrhagia and metrorrhagia, along with taking history, additional tests are required. Analyzes to determine menorrhagia:
- Blood tests are performed to detect iron deficiency (a symptom of anemia) and determine the causes of menorrhagia. For example, you can diagnose diseases of the thyroid gland, ovaries, or coagulation disorders.
- Papp test A cervical smear is done for examination, which is checked for signs of infection, inflammation and cancer.
- Endometrial biopsy. A tissue sample is collected and checked for signs of inflammation, cancer and other abnormalities. This procedure can cause some discomfort and pain, similar to menstrual.
- Ultrasound. Ultrasound is used to obtain images of the uterus, appendages, and ovaries, which can help physicians detect changes in these organs.
- Hysteroscopy. This test allows you to directly visualize the uterus through a tiny camera that is inserted through the vagina and cervix.
The complex of diagnostic measures is selected by the doctor after taking the history individually for each patient.
Treatment and Prevention
A variety of methods can be used to alleviate the symptoms and treat menorrhagia or metromenorrhagia. The choice depends on the patient's age, medical history, desired result and intention to become pregnant in the future. Surgical techniques are usually used in patients who do not respond to drug therapy.
Methods of treatment:
Hormone therapy. Oral contraceptive pills, hormonal IUDs can reduce bleeding by restoring the disturbed balance of hormones and making cycles more regular.
- Other drugs. Vitamin supplements will help eliminate iron deficiency associated with anemia. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can relieve menstrual cramps and reduce blood loss. Funds that help to thicken the blood, in some cases, prescribed to patients with blood clotting disorders.
- Removal of fibrosis. Heavy bleeding caused by myomas can be treated by removing them. Embolization of the uterine artery disrupts the blood supply to fibroids, and focused ultrasound ablation destroys the fibrous tissue. Uterine fibroids can also be removed surgically. Myomectomy is performed either through small incisions of the anterior abdominal wall, or by inserting surgical instruments through the vagina and cervix.
- Endometrial removal. Removing or thinning the endometrial membrane can help reduce heavy bleeding in women. This technique is used in women who are not planning a pregnancy.
- Hysterectomy. Women who continue to suffer from the symptoms of menorrhagia and no longer want to get pregnant, may consider the option of hysterectomy, that is, the removal of the uterus. After surgery, the woman stops her menstrual cycles and she can no longer become pregnant. This procedure is performed under general anesthesia and requires hospitalization.
Unfortunately, it is not always possible to identify the causes of the development of the disease and to diagnose the main pathology.Therefore, in medicine isolated so-called idiopathic menorrhagia. This means that the pathogenesis of the disease is not always clear.
And although there are no precise recommendations for the prevention of this condition, every woman can try to prevent the development of pathologies that are risk factors. To do this, she needs to carefully monitor her health, regularly visit a gynecologist and prophylactically take the prescribed tests.
Menorrhagia - what is it?
Menorrhagia is observed in almost every third woman. At the same time, they remain unnoticed for a long time. Allocate the primary and secondary forms of this pathology. Secondary occurs after normal menstruation, whereas primary menorrhagia occurs during the first cyclical bleeding.
This pathology must be able to be distinguished from metrorrhagia. It is acyclic (occurring between normal menstruation) uterine bleeding. This is a symptom of dangerous gynecological diseases.
Causes and mechanism of development of menorrhagia
Menorrhagia (hypermenorrhea) occurs for a variety of reasons. The main risk factors are:
- Disruption of hormonal balance. Most often, abundant menstruation is characteristic of women in transition and pre-menopausal periods. Hormonal failure can cause diseases of the ovaries (tumors, cysts, oophoritis), pathology of the hypothalamic-pituitary system, the thyroid gland and the adrenal glands. Often, metrorrhagia occurs when irrational use of hormonal drugs.
- Pathology of the female genital organs (cysts, polyps, cervical erosion, benign and malignant tumors, endometritis, cervicitis, salpingo-oophoritis).
- Prolonged use of intrauterine devices.
- Blood clotting disorder. It is possible on the background of taking antiplatelet agents and anticoagulants, lack of vitamin K in the body, low platelet count and impaired production of blood coagulation factors.
- General somatic diseases (hepatitis, nephritis, cardiac pathology).
- Sharp change of climatic conditions.
- Hard physical labor.
In the pathogenesis of menorrhagia are the following changes:
- violation of control over the updating of the functional layer of the endometrium (uterine mucosa) by the nervous system,
- failure of hormonal regulation
- increased vascular bleeding due to weakness of the walls or other disorders.
The development of metrorragy is based on completely different processes. At the same time, cyclic regulary (bleeding) may not change.
Symptoms and diagnosis of the disease
Hypermenorrhea (heavy blood loss) may be the only sign. At the same time, blood is released to the outside in the form of clots. Often this pathology is accompanied by general symptoms in the form of weakness, dizziness and periodic fainting. The reason is blood loss.
In menorrhagia, the duration of bleeding exceeds a week, while the physiological norm is 3-7 days. In young girls, menstruation lasts an average of 2-4 days. Additional symptoms may be:
- Bleeding other localization and bleeding gums. Possible, if the cause of heavy and prolonged periods have become diseases of the blood system.
- Lower abdominal or lower back pain. Possible with neoplasms.
- Difficulty urinating and defecating. Observed in tumors when the intestine and bladder are compressed.
- Pathological discharge between menstruation.
- Difficulties in conceiving a child.
- Violation of menstruation as dysmenorrhea (painful bleeding).
- Acyclic bleedings.
- Discomfort during sexual intercourse.
- Signs of intoxication in the body in the form of fever, weight loss and malaise. Observed in chronic infectious diseases and cancer.
In the presence of menorrhagia (heavy and prolonged menstrual periods), it is required to consult a gynecologist and be examined. For the diagnosis will need:
- Poll. Going obstetric history, as well as the time of the first complaints.
- Physical examination (palpation of the abdomen, listening to the lungs and heart, percussion).
- General clinical blood and urine tests.
- Pregnancy test. The level of chorionic gonadotropin, which rises at conception of a child, is assessed.
- Vaginal examination on obstetric chair.
- Ultrasound. Allows you to assess the condition of the uterus, bladder and appendages.
- Hysteroscopy (endoscopic examination of the uterus).
- Cytological analysis. Required for suspected cancer pathology.
- Coagulogram. Helps assess the state of the blood coagulation system.
- CT or MRI.
- Examination of smears.
- Evaluation of hormonal levels. The blood levels of progesterone, estrogen, follicle-stimulating and luteinizing hormones, prolactin are determined.
- Blood chemistry.
- Analysis for tumor markers. Conducted with suspected neoplasms.
Causes of Menorrhagia
Menorrhagia is associated with structural changes in the lining of the uterus at the time of menstruation. To understand the mechanism of its development, it is necessary to recall the cyclical physiological processes occurring in the uterine mucosa and organs functionally associated with it.
The menstrual cycle is the time elapsed from the beginning of the menstrual bleeding to the beginning of the next. The first day of the cycle is also the first day of menstruation, and its last day coincides with the beginning of the next menstruation. Due to the menstrual cycle, a woman realizes reproductive function, that is, she can conceive and bear a child.
The menstrual cycle always consists of joint sequential changes in the ovaries and uterus under the control of the central nervous system, more precisely, the pituitary and hypothalamus.
A normal menstrual cycle is always two-phase. The first (follicular) phase is accompanied by the maturation of an egg in the ovary. It is located in the follicle - vesicle containing follicular fluid. At the end of the maturation of the egg (the middle of the cycle) the follicle breaks and releases it outside the ovary (ovulation). In the mucous membrane of the uterus (endometrium) at the same time, the processes of growth (proliferation) of the inner layer begin. The endometrium becomes thick, loose, germinates with blood vessels, so it prepares the uterus for a potential pregnancy: if the egg is fertilized and falls through the fallopian tubes into the uterine cavity, the expanded endometrium becomes the site of the fetus.
If fertilization does not occur within two days, the egg cell dies, and all changes in the endometrium during the first follicular phase of the cycle begin to be eliminated. The second (luteal) phase of the cycle is accompanied by rejection of the enlarged endometrium and ends with the evacuation of the uterus contents to the outside - menstruation. Regeneration (recovery) of the endometrium begins 36 hours after the onset of bleeding.
All of these changes in the uterus and ovaries occur with the controlled participation of hormones. The maturation of the follicle and ovule accompanies the follicle-stimulating hormone (FSH) hormone of the pituitary gland, and the proliferation of the endometrium is stimulated by estrogens. After ovulation, the luteinizing (LH) hormone of the pituitary gland dominates in the ovary, and progesterone is responsible for changes in the uterus.
All the cyclic actions of the pituitary, ovaries and uterus are "watched" by the hypothalamus located in the brain.
Thus, a change in the normal functioning of any link in the hypothalamus-pituitary-ovaries-uterus system can lead to a change in the nature of menstrual function.
The physiological reasons for the appearance of menorrhagia are:
- Psycho-emotional disorders, overwork,
- Changing the nature of food: fermented milk diet causes the liver to produce substances that reduce blood clotting.
- Incorrectly dosed exercise. Sports or heavy physical labor during and on the eve of menstruation result in impaired uterine contractility and improper rejection of the endometrium.
- Sharp change of climatic conditions.
- Impaired function of the liver, endocrine glands, thyroid gland (hypothyroidism) or blood coagulation system.
- Lack of vitamins involved in the blood coagulation system (C, P, K, calcium, and others).
- The period of formation of menstrual function (puberty) or its extinction (menopause).
- Acceptance of hormonal drugs, aspirin, anticoagulants.
When such causes are eliminated, normal menstrual function stabilizes.
The pathological causes of menorrhagia always imply the presence of a disease accompanied by menstrual disorders, namely:
Symptoms and signs of menorrhagia
Menorrhagia is clinically manifested by prolonged (more than a week) menstrual bleeding, sometimes the interval between them can be reduced (less than three weeks). The period of the most profuse bleeding, as a rule, takes no more than three days. A distinctive feature of menorrhagia is the presence of menstrual blood with clots. Since in the endometrium, the processes of rejection occur unevenly, blood, before pouring out, accumulates in the uterine cavity and manages to clot and form clots.
Significant menstrual blood loss affects the general condition of patients with menorrhagia, in the case of anemia, weakness, dizziness appear, and fainting is possible.
If menorrhagia appears on the background of cervical or uterine polyps, menstruation becomes not only plentiful and long, pain in the abdomen appears. Fibromyoma of the uterus, especially with a central location in the submucosal layer, also causes pain during menstruation.
The diagnosis of menorrhagia involves a consistent diagnostic search for the cause of its occurrence. Due to the very large number of possible causes of the occurrence of this symptom, the following are performed sequentially:
- Conversation. It is important to find out when menorrhagia appeared, whether it has an obvious cause (stress, fatigue, etc.), the nature of the bleeding and the presence of associated symptoms (especially pain).
- Gynecological examination. In the presence of myoma node in the uterine cavity, the size of the uterus and its consistency can be changed, and cervical polyps on the long leg are visualized in the area of the external pharynx when viewed in mirrors. The uterus on palpation and dislocation can be painful. The presence in the vagina whiter will indicate an infectious-inflammatory process.
- Material collection (contents of the vagina and cervical canal) for laboratory testing.
- Hormonal examination according to the phases of the cycle. Estradiol, FSH, LH, progesterone are determined.
- A blood test to determine the degree of anemia.
- Ultrasound scan of the pelvic cavity. It allows you to see the follicles in the ovaries (or their absence), assess the condition of the endometrium relative to the phase of the cycle, see myoma, polyps or ovarian tumors.
- Hysteroscopy. Allows you to visually examine the entire uterine cavity, detect and immediately remove the polyp and pick up the material (endometrium) for histological examination.
Menorrhagia - main symptoms:
- Pallor of the skin
- The extension of the flow of menstruation
- Abundant menstrual flow
Menorrhagia - profuse blood loss during menstruation, a form of hypermenstrual syndrome (hyperpolymenorrhea - a violation of the cycle, characterized by monthly large blood loss). The physiological norm of blood loss during this period is up to 150 ml. Approximately 30% of women suffer, but not all seek medical help.
The causes of menorrhagia are varied:
- Hormonal imbalance, especially characteristic in premenopausal (the period before menopause, in which the synthesis of sex hormones is reduced), in transitional age, during pregnancy. In other cases, fluctuations in hormonal levels are a risk factor.
- Hypothalamic-pituitary disorders.
- Pathologies of the reproductive organs that have arisen against the dishormonal background, the cause of bleeding in 80% of cases. Such diseases include fibroids (hormone-dependent neoplasm of the uterus), polyps (endometrial proliferation in the form of education on the pedicle or a broad base), ovarian dysfunction (impaired ovarian hormone production), adenomyosis (endometrial germination in the uterine muscle layer).
- Idiopathic menorrhagia - unidentified causes.
- Inflammation of the urogenital area.
- Intrauterine contraceptives.
- Blood diseases associated with coagulation disorders: thrombocytopenia (decrease in platelet concentration), lack of vitamin K.
- Acceptance of anticoagulants (drugs that inhibit blood clotting).
- Burdened family history (in the family there are direct relatives suffering from the same disease).
- Diseases of the thyroid gland, cardiovascular system, renal structures, liver.
- Stress, climate change.
- Heavy physical exertion.
- Ectopic pregnancy, miscarriage.
- Postpartum hemorrhage.
The nervous system has a huge effect on the hormones of a woman. Even with normal physical well-being, psycho-emotional overwork can lead to increased blood flow during menstruation.
In adolescent girls, hypermenorrhea is not uncommon because of the imbalance between the content of estrogen and progesterone, which affect endometrial rejection. Pathological enlargement of the thyroid gland, genital infections, poor clotting exacerbate the flow of menstruation.
Symptoms of menorrhagia
The main manifestation of menorrhagia are prolonged and abundant menstrual flow with blood clots. Prolonged and severe blood loss can lead to anemia, manifested in the deterioration of health, weakness, dizziness, the development of fainting states. Often with menorrhagia there are bleeding from the gums and nose, bruises, bruises on the body. With menorrhagia, menstruation is so abundant that a woman has to replace a hygienic tampon or pad every hour and sometimes more often.
Main causes of menorrhagia
The causes leading to the development of menorrhagia can be the following disorders:
- Hormonal instability. Especially expressed in patients with pre-menopausal and transitional age. The instability of the hormonal background during these physiological periods increases the risk of menorrhagia.
- Diseases of the reproductive system: fibroids, polyps, uterine adenomyosis, ovarian dysfunction. Develop due to hormonal imbalance in the body and serve as the cause of menorrhagia in 80% of women.
- Use of intrauterine contraceptives. Menorrhagia in this case is an undesirable side effect, which may require removal of the IUD (intrauterine device).
- Diseases associated with impaired blood coagulation (for example, vitamin K deficiency, thrombocytopenia), as well as taking certain medications that affect clotting (anticoagulants). Increased bleeding that accompanies a violation of the blood coagulation system, may manifest abundant menstruation - menorrhagia.
- Hereditary menorrhagia. Often, menorrhagia is a family disease transmitted by the female line of inheritance.
- Diseases of the pelvic organs, thyroid, kidney, liver, heart. In menorrhagia, the patient should consult with an endocrinologist and a general practitioner to rule out endocrine and somatic causes of heavy menstruation.
- Excessive power loads, overwork, stressful situations, change of climatic conditions. All the factors that cause the body to adapt to new conditions and pressures, can trigger the development of menorrhagia.
Diagnosis of menorrhagia
The diagnosis of "menorrhagia" is made on the basis of complaints and signs of excessive blood loss. For any uterine bleeding excluded pregnancy, especially ectopic. The pregnancy test, the determination of chorionic gonadotropin in the blood, allows to exclude pregnancy and the pathology associated with it.
For the diagnosis of menorrhagia, the data of history (medication, complications of previous pregnancies and childbirth, etc.) are important. To determine the causes of menorrhagia, the vagina and cervix are examined for foreign bodies, traumatic injuries, polyps, tumors, inflammatory or atrophic changes.
If suspected uterus and ovarian pathology, diagnostic procedures are performed: ultrasound of the pelvic organs, hysteroscopy, cervical biopsy, curettage and endometrial tissue analysis. Hemoglobin is examined by methods of laboratory diagnosis in menorrhagia, biochemical blood analysis and coagulation are performed, hormonal background is determined, CA markers 19-9, CA-125 are determined. To identify pre-cancerous or cancerous cells in the cervix, cytological Pap smear analysis is performed.
Women suffering from menorrhagia are advised to keep a menstrual calendar, which indicates the duration of menstruation, profusion and the nature of the discharge. The abundance of blood loss is determined by the frequency of changing the gasket or tampon.
Therapeutic treatment of menorrhagia
The method of treatment of menorrhagia is selected depending on the cause, profusion and duration of menstrual bleeding. Self-treatment of menorrhagia can only aggravate the disease.
В качестве медикаментозной терапии менорагии для регуляции гормонального баланса назначается длительный прием гормональной контрацепции. Progesterone and estrogen, which are part of oral contraceptives, prevent excessive growth of the endometrium and reduce the amount of discharge during menstruation by more than 40%. Selection of oral contraceptives is carried out on the advice of a gynecologist individually.
Women with menorrhagia are recommended to take iron supplements to avoid iron deficiency anemia. Taking rutin and ascorbic acid will help reduce blood loss. Anti-inflammatory drugs (ibuprofen) that affect the duration and amount of bleeding are used to treat menorrhagia. In case of severe bleeding, hemostatic preparations are prescribed - etamzilat, calcium chloride or gluconate, aminocaproic acid. In case of hormonal imbalance, homeopathic treatment is effective.
For the treatment of menorrhagia using intrauterine systems with levonogestrel. Possessing a contraceptive effect, they prevent endometrial proliferation, reduce its thickness and blood supply. However, if menorrhagia is caused by the use of an intrauterine contraceptive, then it should be removed and other methods and means of protection should be used. Women with menorrhagia are recommended normalization of the regime, proper rest and nutrition. After the cessation of menstrual bleeding, a course of physiotherapeutic procedures is conducted (10-15 sessions of ozokerite and diathermy). Some cases of menorrhagia require surgery.
Surgical treatment of menorrhagia
Surgical gynecology treats menorrhagia for the following indications:
- recurrent menorrhagia,
- physiological disorders or damage to the genitals
- the ineffectiveness of the medical treatment of menorrhagia,
- severe iron deficiency anemia.
For menorrhagia, a hysteroscopy is carried out for diagnostic and therapeutic purposes, allowing to diagnose any uterus pathology (for example, endometrial polyps) and eliminate it. Scraping the uterine cavity allows for a few menstrual cycles to reduce bleeding, after which the menorrhagia resumes.
With prolonged and heavy menstrual bleeding or in the presence of fibroids and polyps, they resort to hysterectomy - prompt removal of the uterus. In some cases, it is possible to conduct its supravaginal amputation. Surgical treatment of menorrhagia is used in women over 40 years of age, at a younger age - only in severe cases. Diseases and tumors of the thyroid gland, causing menorrhagia, are treated either medically or surgically.