Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding. Although heavy menstrual bleeding is a common concern, most women don't experience blood loss severe enough to be defined as menorrhagia. With menorrhagia, you can't maintain your usual activities when you have your period because you have so much blood loss and cramping.

Symptoms

Soaking through one or more sanitary pads or tampons every hour for several consecutive hours

Needing to use double sanitary protection to control your menstrual flow

Needing to wake up to change sanitary protection during the night

Bleeding for longer than 8 days or more than 80ml blood loss.

Passing blood clots larger than a quarter

Restricting daily activities due to heavy menstrual flow

Symptoms of anaemia, such as tiredness, fatigue or shortness of breath

When to call for appointment

You should see us if you experience:

Vaginal bleeding so heavy it soaks at least one pad or tampon an hour for more than two hours

Bleeding between periods or irregular vaginal bleeding

Any vaginal bleeding after menopause

Causes

In some cases, the cause of heavy menstrual bleeding is unknown, but a number of conditions may cause menorrhagia. Common causes include:

Hormone imbalance

Dysfunction of the ovaries

Uterine fibroids

Polyps

Adenomyosis

Pregnancy complications

Cancer

Inherited bleeding disorders

Other medical conditions. A number of other medical conditions, including liver or kidney disease, may be associated with menorrhagia.

Risk factors

Risk factors vary with age and whether you have other medical conditions that may explain your menorrhagia. In a normal cycle, the release of an egg from the ovaries stimulates the body's production of progesterone, the female hormone most responsible for keeping periods regular. When no egg is released, insufficient progesterone can cause heavy menstrual bleeding.

Menorrhagia in adolescent girls is typically due to anovulation. Adolescent girls are especially prone to anovulatory cycles in the first year after their first menstrual period (menarche).

Menorrhagia in older reproductive-age women is typically due to uterine pathology, including fibroids, polyps and adenomyosis. However, other problems, such as uterine cancer, bleeding disorders, medication side effects and liver or kidney disease could be contributing factors.

Complications

Excessive or prolonged menstrual bleeding can lead to other medical conditions, including:

(i) Anaemia – Complete blood count to rule out anaemia, and (ii) Severe pain

Evaluation of HMB

Urine Pregnancy Test – to rule out pregnancy

USG pelvis – would evaluate Fibroids, Adenomyosis, Endometrial polyps, thickened endometrium, polycystic ovaries as a cause.

Hormonal evaluation – including thyroid.

Complete blood count – to rule out anaemia.

Endometrial biopsy – to rule out malignancy.

Treatment of HMB:

Depends on the cause of HMB and whether fertility is also the concern.

Non hormonal medication to reduce blood flow. Eg: Tranexamic acid, Ethamsylate.

Hormonal medication – if not responding to non – hormonal treatment. Hormonal medication could be given in various forms, mainly containing progesterone. They could be oral tablets, injections or Intra – uterine device ( MIRENA ) which when placed inside the uterus would act locally.

Therapeutic endometrial curettage – scraping of the endometrial walls thoroughly, would stop the bleeding.

Hysterectomy ( Uterus removal ) – If not responding to any of the above methods and if family is completed, and preferably if the age is > 45 years.