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Menorrhagia
(Hypermenorrhea)

Definition:
Menorrhagia is excessive and/or prolonged menstrual bleeding. Although about 30% of women have heavy periods, only 10% of women have menorrhagia. On average, menstrual flow occurs every 28 days and lasts for five days. Four tablespoons to one cup (60-250 milliliters) of blood is lost during this time.

Causes:
In some cases the cause of menorrhagia is unknown. However, many conditions have been known to be associated with menorrhagia. These include:
  • Menstrual cycle hormone dysfunction (imbalance)
  • Cervical or endometrial polyps
  • Uterine fibroids
  • Infection (pelvic infections)
  • Blood-clotting disorders
  • Anticoagulant medications (blood thinners)
  • Anti-inflammatory medications (large amounts over a long period of time)
  • Liver, kidney, or thyroid disease
  • Problems with an intrauterine device (IUD)
  • Ectopic pregnancy
  • Ovarian cysts
  • Chronic medical conditions
  • Anticoagulant and anti-inflammatory medications
  • Cancer of the uterus or cervix (rare)
  • Vaginal injury from trauma or sexual abuse
  • Complications from pregnancy, such as miscarriage
Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition. People at greatest risk for menorrhagia include:
  • Adolescent girls who have started menstruation within the last 12-18 months
  • Women approaching menopause
  • Women with hereditary bleeding disorders
  • Women who are obese
Symptoms:
Symptoms of menorrhagia include:
  • Menstrual bleeding lasting more than seven days
  • Unusually heavy bleeding (soaking through a sanitary napkin or tampon every hour)
  • Menstrual flow requiring change of sanitary protection during the night
  • Menstrual flow including large clots
  • Menstrual flow interfering with lifestyle
  • Fatigue and/or shortness of breath (symptoms of anemia)
Diagnosis:
Your healthcare provider will ask about your symptoms and medical history. A physical examination including pelvic exam will be done as part of the evaluation. Tests may include:
  • Pap Test
  • Blood Tests
  • Pregnancy Test
  • Ultrasound–a test that uses sound waves to examine your reproductive organs (uterus and ovaries)
  • Endometrial Biopsy–removal of a sample of endometrial tissue to look for changes in the lining of the uterus
  • Dilation and Curettage (D & C)–scraping of the inner lining of the uterus
  • Hysteroscopy–examination of the cervix and fallopian tubes using a telescope-like viewing device
Treatment:
Treatment of menorrhagia will depend on the underlying cause. Women who experience persistent excessive bleeding should discuss with their healthcare provider whether to take iron supplements to prevent anemia.

If there is no medical disorder causing your menorrhagia, your doctor may prescribe the following:

Medications
These may include:
  • Hormone therapy (estrogen and/or progestrogen hormones by mouth, skin application, vaginal application, or injection)
  • An IUD that releases a progestogenic drug (Mirena)
  • Nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) and mefenamic acid (Ponstel, Ponstan)
Surgical Procedures
Procedures may include:
  • Dilation and curettage (D&C)–the cervix is dilated and the lining of the uterus scraped to remove uterine tissue
  • Operative Hysteroscopy–a long, thin instrument is inserted into the uterus that can aid in removal of a polyp or fibroid
  • Endometrial Ablation or Resection–removal of the lining of the uterus using heat, microwave, or surgical tools. After this procedure, a woman is unable to carry a pregnancy.
  • Hysterectomy–the surgical removal of the uterus. After this procedure, a woman is unable to carry a pregnancy. If the ovaries are also removed, early menopause will follow.
Important Considerations When Choosing Treatment
  • Your age, overall health, and medical history
  • Extent of the condition
  • Cause of the condition
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference
Prevention:
For most women there are no specific steps for prevention. However, if your menorrhagia is caused by a medication, you may prevent the condition by discontinuing use of this medicine.

Menstrual discomfort is better treated with pain relievers such as Motrin and Advil.

 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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