Menorrhagia

Menorrhagia

Menorrhagia is the medical name for abnormally heavy bleeding during menstruation. While many women are too embarrassed to raise the subject or feel that their bleeding is within normal limits, other women request treatment. While heavy periods are inconvenient, they can also lead to anaemia resulting in reduced energy and can have a very significant effect on women and on those around them. Episodes of flooding and embarrassing moments can be
very distressing and disabling.

What causes menorrhagia?

Menorrhagia can be caused by a number of conditions including fibroids, endometriosis, drugs, and polyps or can be due to hormonal changes involving the process of ovulation. Fibroids are benign thickenings of the muscle of the uterus. These are not malignant but are very common with increasing age. They may distort the uterine cavity, increase the blood flow required, and also interfere with the normal contraction mechanism which controls bleeding. Endometriosis is a condition where the lining of the uterus is also present around the ovaries and tubes or other locations outside the uterus. Polyps are thickenings of the lining of the uterus which can increase the surface area of the uterus and cause menorrhagia. Some drugs i.e. Aspirin and Warfarin prevent the clotting mechanism in the body and may result in heavy periods. Hormonal causes are the most common and typically occur because of irregular or delayed ovulation. It is generally caused by the dominance of oestrogen over progesterone resulting in increased cell growth of the lining of the uterus and subsequent heavier bleeding when this lining is shed.

Menorrhagia is a symptom which varies enormously between different populations and age groups. It is at the point where menorrhagia interferes with a woman’s lifestyle and ability to do normal activities that it becomes problematic.

What can be done?

Firstly to combat the effects of menorrhagia iron supplements e.g. Ferrogradumet one a day and improved dietary intake may well help. The next step is to identify the cause for the menorrhagia. This may involve hysteroscopy, laparoscopy, clinical examination or ultrasound of the pelvis. This is primarily looking for fibroids and polyps and other intrauterine pathology. There may be a need for laparoscopy if endometriosis is suspected.

Once we are satisfied that there is no serious cause, a number of different approaches can be applied:

  1. Wait and see this involves, taking some iron tablets and generally looking after yourself.
  2. Take some tablets called Tranexamic Acid 500mg, 4-5-6 times a day on the heavy days to see whether this will reduce your loss. This may well be very effective for 10- 15% of the population. It can cause nausea.
  3. Progesten therapy this involves taking a drug called Provera 10mg from days 14-25 of the cycle and attempting to replace the progesterone that is often not present or in low levels in the pre-menopausal age group. It is quite successful in 15-20% of women and is generally very well tolerated.
  4. Combined pill taking a normal contraceptive pill is frequently associated with much less growth of the endometrium and frequently results in light periods. Unfortunately the pill may not control very heavy bleeding due to endometriosis, fibroids or polyps.
  5. Hysteroscopy and D&C checking for polyps and fibroids. Rarely helps bleeding long term.
  6. Endometrial ablation This is a procedure designed to burn out the lining of the uterus as thoroughly as possible to try to reduce the amount of bleeding. It is effective in 65% of people and there are some small risks associated with the procedure. We use a thermal balloon to burn out the uterine lining.
  7. Mirena device – This is a progesterone coated intro-uterine device which causes marked thinning of the lining of the uterus. It tends to be very popular and effective. It is successful and costing $40 on a prescription.
  8. Implanon – Implanon is a progesterone implant which when placed under the skin results in thinning of the endometrium and generally very light bleeding. It is very successful and costing $40 on prescription. It can be removed if you are not happy with it.
  9. Hysterectomy – This is a major operation and the decision to perform a hysterectomy is not taken lightly. It is the removal of the actual womb including the cervix. The indications for hysterectomy are primarily menorrhagia, unresponsive to other measures. It can be performed either laparoscopically, vaginally or abdominally depending on the size of the uterus and the degree of laxity of the pelvic support. It obviously offers 100% guaranteed result.