Excessive Menstrual Bleeding – Menorrhagia - Occupational and Environmental Medicine

February 1, 2017

Excessive menstrual bleeding, clinically known as menorrhagia, is a prolonged or abnormally heavy menstrual period. The condition is a common problem, affecting one in every five women.

Heavy menstrual bleeding is defined as blood loss greater than about 80 milliliters each cycle. Since it can be difficult to measure volume of menstrual blood loss, an easier indicator for doctors is the frequency at which a woman changes her sanitary pads or tampons, as well as menstrual clotting — especially clots larger than 1 inch in diameter.

The need to continuously change sanitary protection can impact quality of life and trigger stress. Heavy menstrual bleeding can make it difficult for some women to carry out day-to-day responsibilities. More importantly, menorrhagia may be a symptom of a more serious condition.

Untreated heavy or prolonged bleeding can stop women from living their life to the fullest. It also can cause anemia. Anemia is a common blood problem that can leave people feeling tired or weak.

Causes

Some of the causes of excessive menstrual bleeding include:

Hormonal Imbalance – Estrogen and progesterone are the hormones that regulate the thickening of the endometrium, which is the lining of the uterus that is shed in each menstrual cycle. If the hormones are out of balance, the endometrium may become thicker than normal, resulting in a heavy period.

Fibroids – Fibroids are noncancerous growths in the uterus that can cause feelings of pressure and pain as well as heavy periods.

Polyps – Polyps are another form of noncancerous, fleshy growths on the uterine lining. They are unlike most colon polyps and more like skin tags. In addition to heavy periods, they may cause bleeding between periods and bleeding after menopause.

Endometriosis – In this disease, the endometrial tissue that normally makes up the lining of the uterus is found outside of the uterus, sometimes on the ovaries, bladder, bowel or elsewhere in the lower abdomen. While some women with endometriosis have no symptoms, the disease can cause pain ranging from mild to severe, as well as infertility and heavy, painful periods.

Intrauterine device (IUD) – Menorrhagia is a well-known side effect of using a nonhormonal intrauterine device for birth control. When an IUD is the cause of excessive menstrual bleeding, you may need to remove it.

Pregnancy complications – A single, heavy, late period may be due to a miscarriage. If bleeding occurs at the usual time of menstruation, however, miscarriage is unlikely to be the cause. An ectopic pregnancy — implantation of a fertilized egg within the fallopian tube instead of the uterus — also may cause menorrhagia.

Cancer – Rarely, uterine cancer, ovarian cancer and cervical cancer can cause excessive menstrual bleeding.

Medications – Certain drugs, including anti-inflammatory medications and anticoagulants, can contribute to heavy or prolonged menstrual bleeding.

Other medical conditions – A number of other medical conditions, including pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease, may be associated with menorrhagia.

Neoplasia – This condition is marked by the growth of new tissue and ranges from a simple thickening of the uterine lining to precancerous or cancerous growths.

Blood Clotting Disorders – Conditions such as von Willebrand’s Disease prevent the blood from clotting properly, resulting in a heavier than normal flow.

Stress and lifestyle factors – Gaining or losing a significant amount of weight, dieting, changes in exercise routines, travel, illness, or other disruptions in a woman’s daily routine can have an impact on her menstrual cycle.

Birth control pills – Most birth control pills contain a combination of the hormones estrogen and progestin (some contain progestin alone). The pills prevent pregnancy by keeping the ovaries from releasing eggs. Going on or off birth control pills can affect menstruation. Some women have irregular or missed periods for up to six months after discontinuing birth control pills. This is an important consideration when you are planning on conception and becoming pregnant. Women who take birth control pills that contain progestin only may have bleeding between periods.

Risk Factors

Menorrhagia is most often due to a hormone imbalance that causes menstrual cycles without ovulation. 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.

Menstrual cycles without ovulation (anovulatory cycles) are most common among two separate age groups –

Adolescent girls who have recently started menstruating – Girls are especially prone to anovulatory cycles in the first year after their first menstrual period (menarche).
Older women approaching menopause – Women ages 40 to 50 are at increased risk of hormonal changes that lead to anovulatory cycles.
Weight – Being either excessively overweight or underweight can increase the risk for dysmenorrhea and amenorrhea.
Menstrual Cycles and Flow – Longer and heavier menstrual cycles are definitely associated with painful cramps.
Pregnancy History – Women who have had a higher number of pregnancies are at increased risk for menorrhagia. Women who have never given birth have a higher risk of dysmenorrhea, while women who first gave birth at a young age are at lower risk.
Smoking – Smoking can increase the risk for heavier periods.
Stress – Physical and emotional stress may block the release of luteinizing hormone, causing temporary amenorrhea.

Symptoms

In general, bleeding is considered excessive when a woman soaks through enough sanitary products (sanitary napkins or tampons) to require changing every hour. In addition, bleeding is considered prolonged when a woman experiences a menstrual period that lasts longer than seven days in duration. The following are the most common (other) symptoms of menorrhagia. However, each individual may experience symptoms differently. Symptoms may include –

Heavy vaginal bleeding resulting in the saturation of one or more sanitary pads or tampons every hour for several hours
Heavy bleeding requiring the use of double sanitary protection
Having to change pads or tampons in the middle of the night
Menstrual flow or bleeding lasting more than 1 week
Passage of blood clots which are the size of a quarter or larger
Inability to perform regular daily activities because of the bleeding
Signs and symptoms of anemia which include tiredness, fatigue and shortness of breath
Constant lower abdominal and pelvic pain.

The symptoms of menorrhagia may resemble other menstrual conditions or medical problems. Always consult your health care provider for a diagnosis.

Complications

Iron deficiency anemia – In this common type of anemia, your blood is low in hemoglobin, a substance that enables red blood cells to carry oxygen to tissues. Low hemoglobin may be the result of insufficient iron.
Severe pain – Along with heavy menstrual bleeding, you might have painful menstrual cramps (dysmenorrhea). Sometimes the cramps associated with menorrhagia are severe enough to require prescription medication or a surgical procedure.
Infertility – Some conditions associated with heavy bleeding, such as ovulation abnormalities, fibroids, or endometriosis, are important contributors to infertility.

Treatment

Drug Therapy

Iron supplements – To get more iron into your blood to help it carry oxygen if you show signs of anemia.
Ibuprofen (Advil) – To help reduce pain, menstrual cramps, and the amount of bleeding. In some women, NSAIDS can increase the risk of bleeding.
Birth control pills – To help make periods more regular and reduce the amount of bleeding.
Intrauterine contraception (IUC) – To help make periods more regular and reduce the amount of bleeding through drug-releasing devices placed into the uterus.
Hormone therapy (drugs that contain estrogen and/or progesterone) – To reduce the amount of bleeding.
Desmopressin Nasal Spray (Stimate) – To stop bleeding in people who have certain bleeding disorders, such as von Willebrand disease and mild hemophilia, by releasing a clotting protein or “factor”, stored in the lining of the blood vessels that helps the blood to clot and temporarily increasing the level of these proteins in the blood.
Antifibrinolytic medicines (tranexamic acid, aminocaproic acid) – To reduce the amount of bleeding by stopping a clot from breaking down once it has formed.

Surgical Treatment

Dilation and Curettage (D&C) – A procedure in which the top layer of the uterus lining is removed to reduce menstrual bleeding. This procedure might need to be repeated over time.
Operative hysteroscopy – A surgical procedure, using a special tool to view the inside of the uterus, that can be used to help remove polyps and fibroids, correct abnormalities of the uterus, and remove the lining of the uterus to manage heavy menstrual flow.
Endometrial ablation or resection – Two types of surgical procedures using different techniques in which all or part of the lining of the uterus is removed to control menstrual bleeding. While some patients will stop having menstrual periods altogether, others may continue to have periods but the menstrual flow will be lighter than before. Although the procedures do not remove the uterus, they will prevent women from having children in the future.
Hysterectomy – A major operation requiring hospitalization that involves surgically removing the entire uterus. After having this procedure, a woman can no longer become pregnant and will stop having her period.

Lifestyle Changes

Exercise – Exercise may help reduce menstrual pain.
Sexual Activity – There have been reports that orgasm reduces the severity of menstrual cramps.
Applying Heat – Applying a heating pad to the abdominal area, or soaking in a hot bath, can help relieve the pain of menstrual cramps.
Menstrual Hygiene – Change tampons every 4 – 6 hours. Avoid scented pads and tampons; feminine deodorants can irritate the genital area. Douching is not recommended because it can destroy the natural bacteria normally present in the vagina. Bathing regularly is sufficient.

Alternative Treatment

Acupuncture and Acupressure – Some studies have reported relief from pelvic pain after acupuncture or acupressure, a technique that applies small pins or pressure to specific points on the body. More research is needed.

Yoga and Meditative Techniques – Yoga and meditative techniques that promote relaxation may help relieve menstrual cramps.

Herbs and Supplements – Generally, manufacturers of herbal remedies and dietary supplements do not need approval from the Food and Drug Administration to sell their products.

Black cohosh (also known as Cimicifuga racemosa or squawroot) contains a plant estrogen and is the most studied herbal remedy for treating menopausal symptoms, including dysmenorrhea, although most studies have indicated it is ineffective. Headaches and gastrointestinal problems are common side effects. It should not be taken for more than 6 months.

Ginger tea or capsules may help to relieve nausea and bloating.

Magnesium supplements may be helpful for relieving dysmenorrhea. Some women also report benefit with vitamin B1 (thiamine) supplements.

Aromatherapy with topically-applied lavender, sage, and rose oils may help ease menstrual cramps, according to some small studies.

Pycnogenol, an extract from the bark of the French maritime pine tree, may help reduce menstrual pain and discomfort, according to some small studies.

Reference –

https://my.clevelandclinic.org/health/healthy_living/hic_Coping_with_Families_and_Careers/hic_Normal_Menstruation/hic-abnormal-menstruation

https://www.womentowomen.com/menstruation/menorrhagia-and-hypermenorrhagia/

http://www.heroption.com/

http://www.drnorthrup.com/heavy-menstrual-bleeding-menorrhagia/

http://www.paullarsonobgyn.com/excessive-uterine-bleeding/

http://www.bostonscientific.com/en-US/health-conditions/heavy-menstrual-bleeding.html

http://natural-fertility-info.com/heavy-menstrual-bleeding.html

http://womenshealth.about.com/od/abnormalbleeding/a/causemenorrhagi.htm

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