Menorrhagia
Menorrhagia is characterized by abnormally heavy or prolonged menstrual bleeding, typically exceeding 80 milliliters or lasting more than seven days. This condition can arise from a variety of causes, including anatomical abnormalities like uterine fibroids, hormonal imbalances, certain medical conditions (such as blood clotting disorders or liver disease), and the use of specific medications that affect blood clotting. Symptoms may include excessive bleeding at regular intervals and signs of anemia due to blood loss.
Treatment for menorrhagia can involve medical or surgical approaches, tailored to the underlying cause and severity. Medical options may include hormonal therapies or medications to manage bleeding, while surgical treatments range from procedures like dilation and curettage to hysterectomy, which is definitive for cases where other treatments have failed. In patients with fibroids who wish to preserve fertility, myomectomy might be considered. In severe cases, blood transfusions may be necessary to address anemia. Understanding the causes and available treatments for menorrhagia can help individuals seeking care to navigate their options effectively.
Menorrhagia
Anatomy or system affected: Blood, reproductive system, uterus
Definition: Excessively heavy or prolonged menstrual flow
Causes: Uterine abnormalities (fibroids, adenomyosis); hormonal imbalances; blood clotting disorders; liver or thyroid disease; blood thinners (coumadin, heparin); uterine and other reproductive tract cancers
Symptoms: Excessive uterine bleeding, sometimes anemia
Duration: Chronic
Treatments: Depends on cause and severity; may include iron supplements, oral contraceptives or medroxyprogesterone, hormone injections to induce menopause, high-dose estrogens, dilation and curettage (D & C), thermal ablation, endometrial polyp or fibroid resection, placement of progesterone-impregnated IUD, myomectomy, hysterectomy
Causes and Symptoms
Menorrhagia can be caused by many disorders: anatomic abnormalities of the uterus, hormonal imbalances, certain medical conditions, medications, and malignancy. Common anatomic causes are uterine fibroids and adenomyosis. Irregular menstrual cycles resulting from hormonal imbalances can be associated with menorrhagia. Medical conditions such as blood clotting disorders and liver or thyroid disease contribute to menorrhagia. Medications that prevent blood clotting, such as coumadin or heparin, can lead to increased menstrual flow. Uterine and other reproductive tract cancers can result in unusually heavy menstrual flow.
Symptoms of menorrhagia are uterine bleeding that is excessive (more than 80 milliliters) and/or bleeding that lasts for more than seven days. Unlike metrorrhagia, bleeding occurs at regular intervals. The patient can become anemic and exhibit symptoms of either acute or chronic blood loss. Symptoms and signs which suggest the cause of menorrhagia may be present, such as large palpable fibroids, or evidence of hypothyroidism or liver disease.
Treatment and Therapy
Menorrhagia can be treated via a medical or a surgical approach. The selection of treatment often depends on the cause and severity of the menorrhagia. If menorrhagia is the result of conditions amenable to medical treatment (such as a thyroid disorder), then control of these conditions may decrease the bleeding. If the patient has irregular cycles (for example, because of lack of ovulation), then hormones such as oral contraceptive pills or medroxyprogesterone may be used to regulate the cycles and decrease menstrual flow. A patient who is nearing the menopause can receive hormone injections that place her into an earlier artificial menopause, and hence eliminate menstrual bleeding altogether. If the patient encounters acute and profuse bleeding, then high-dose estrogens may be given.
In 2020, the US Food & Drug Administration approved a new drug to treat menorrhagia in women with fibroid tumors. Oriahnn, the drug, is a combination of estrogen and progestin. It comes in capsule form.
If menorrhagia is resistant to medical management, then surgical treatment may be necessary. Examples of procedural treatments for menorrhagia are dilation and curettage (D & C), for acute, profuse bleeding; thermal ablation of the endometrial lining; hysteroscopic resection of endometrial polyps or fibroids; and placement of a progesterone-impregnated intrauterine device (IUD). Hysterectomy is the definitive surgery for menorrhagia, no matter what the cause, since menstrual bleeding cannot occur without the uterus. Patients with large fibroids or adenomyosis often are not responsive to medical management. These patients would be candidates for hysterectomy. In patients with large fibroids and menorrhagia who wish to retain childbearing potential, a myomectomy may be performed instead of hysterectomy. If a patient is suspected or known to have a malignancy of the reproductive tract that is causing menorrhagia, then surgical management is the appropriate treatment.
Finally, patients can become severely anemic from menorrhagia, and blood transfusion may be necessary. Mild anemia can be treated with iron supplementation.
Bibliography
Badash, Michelle. "Heavy Menstrual Bleeding." Health Library, September 27, 2012.
"FDA Approves New Option to Treat Heavy Menstrual Bleeding Associated with Fibroids in Women." US Food & Drug Administration, 29 May 2020, www.fda.gov/news-events/press-announcements/fda-approves-new-option-treat-heavy-menstrual-bleeding-associated-fibroids-women#:~:text=The%20U.S.%20Food%20and%20Drug,with%20uterine%20leiomyomas%20(fibroids)%20in. Accessed 4 Aug. 2023.
Golub, Sharon. Periods: From Menarche to Menopause. Newbury Park, Calif.: Sage, 1992.
"Heavy Menstrual Bleeding." Centers for Disease Control and Prevention, December 12, 2011.
Icon Health. Menorrhagia: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, Calif.: Author, 2004.
Kasper, Dennis L., et al., eds. Harrison’s Principles of Internal Medicine. 16th ed. New York: McGraw-Hill, 2005.
"Menorrhagia (Heavy Menstrual Bleeding)." Mayo Clinic, June 25, 2022, www.mayoclinic.org/diseases-conditions/menorrhagia/diagnosis-treatment/drc-20352834. Accessed Aug. 4 2023.
O’Donovan, Peter, Paul McGurgan, and Walter Prendiville, eds. Conservative Surgery for Menorrhagia. San Francisco: Greenwich Medical Media, 2003.
Stenchever, Morton A., et al. Comprehensive Gynecology. 4th ed. St. Louis, Mo.: Mosby/Elsevier, 2006.
Tierney, Lawrence M., Stephen J. McPhee, and Maxine A. Papadakis, eds. Current Medical Diagnosis and Treatment 2006. New York: McGraw-Hill Medical, 2006.