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Menorrhagia - abundant menstrual bleeding

Menorrhagia - abundant menstrual bleeding



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Menorrhagia is a medical term for excessive or prolonged menstrual bleeding - and for menstrual periods that are also abundant and prolonged. The condition is also known as hypermenorrhoea.

At some point in your reproductive life, they probably had heavy bleeding during menstruation. If you are like some women, you have such bleeding almost every cycle. Menorrhagia is a medical term for excessive or prolonged menstrual bleeding - and for menstrual periods that are also abundant and prolonged. The condition is also known as hypermenorrhoea.

The menstrual cycle is not the same for every woman. Normal menstrual flow occurs every 21 to 35 days, lasts 4 to 5 days and results in a total blood loss of 30 to 40 milliliters. Your menstruation may be regular or irregular, with low flow or abundance, painful or painless, long or short and may be considered normal.

Menorrhagia refers to the loss of 80 milliliters of blood or more during the menstrual cycle. Although heavy menstrual bleeding is common among women who are just before menopause, few women have a severe enough blood loss to be defined as menorrhagia. Personal care and treatment measures can help.

Menorrhagia - signs and symptoms

Menstrual signs and symptoms may include:

- Menstrual flow that requires one or more tampons per hour for several consecutive hours;
- The need to use double protection to control menstrual flow;
- The need to change the protection during the night;
- Menstruation lasting more than 7 days;
- Menstrual flow including large blood clots;
- The abundant menstrual flow that affects your normal lifestyle;
- Constant pain in the lower abdomen during menstruation;
- Fatigue, exhaustion or difficulty breathing (symptoms of anemia).

Causes of menorrhagia

In some cases, the cause of heavy menstrual bleeding is unknown, but a certain number of conditions can cause menorrhagia. Common causes include hormonal imbalance. At a normal menstrual cycle, the balance between the hormones estrogen and progesterone regulates the accumulation of endometrium which is eliminated during menstruation.

If a hormonal imbalance occurs, the endometrium develops excessively and is eventually eliminated by abundant menstrual bleeding. Hormonal imbalance occurs most often in adolescent girls and women who are approaching menopause. If menorrhagia is caused by a certain hormonal imbalance, such as thyroid disease, abundant menstrual flow can often be controlled with hormone-based medications.

However, improper use of hormone treatment may also be a direct cause of menorrhagia.

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Menorrhagia: causes and risk factors

- Uterine fibroids. These non-cancerous (benign) tumors of the uterus appear during pregnancy. Uterine fibroids may cause more extensive menstrual bleeding than normal and prolonged.

- Polyps. Small, benign excretions on the endometrium (uterine polyps) that can cause extensive and prolonged menstrual bleeding. Uterine polyps most often occur in women of reproductive age due to an increased hormone level.

- Ovarian dysfunction. Lack of ovulation (anovulation) can cause hormonal imbalance and result in menorrhagia.

- Adenomyosis. This condition occurs when the glands in the endometrium are completely covered by the uterine muscle and often causes heavy bleeding and pain. Adenomyosis occurs most often in middle-aged women who have had many children.

- Intrauterine device (IUD). Menorrhagia is a well-known side effect of using a non-hormonal intrauterine device as a method of contraception. When the IUD is the cause of excessive menstrual bleeding, it is necessary to remove it.

- Complications during pregnancy. A single abundant menstruation that occurs late may be the effect of a pregnancy loss. However, if bleeding occurs during the period when menstruation occurs normally, it is unlikely that pregnancy loss will be the cause. An ectopic pregnancy - implanting a fertilized egg into the fallopian tubes instead of the uterus - can also be the cause of menorrhagia.

- Cancer. In rare cases, uterine cancer, ovarian cancer and cervical cancer can cause excessive menstrual bleeding.

- Medication treatments. Certain drugs, including anti-inflammatory and anticoagulant drugs (to prevent blood clots), can contribute to abundant and prolonged menstrual bleeding.

- Other medical conditions. Some other effects, including pelvic inflammatory disease (BIP), thyroid problems, endometriosis and liver and kidney disease can cause menorrhagia.

Any woman can have abundant menstrual bleeding at any time in her reproductive life. Especially young women who do not yet regularly ovulate tend to have menorrhagia in the 12 to 18 months after their first menstruation. Older women who are approaching menopause often face a hormonal imbalance that can cause menorrhagia.

Women with a higher risk of menorrhagia are also those with hereditary bleeding dysfunction.

When to go to the doctor?

Doctors generally recommend annual pelvic exams and regular Pap smears to all sexually active women over the age of 21. However, if you have heavy or irregular vaginal bleeding, schedule an appointment with your doctor and make sure you note when the time of the month is bleeding.

If you have abundant vaginal bleeding - use at least one tampon per hour for several hours in a row - go to the doctor. Contact your doctor if you have severe menstrual pain that does not respond to home treatment or if you have menopausal vaginal bleeding.

Testing and diagnostics

The doctor will most likely ask you what your medical history is and about your menstrual cycles. You may be asked to keep a diary of bleeding and bleeding days, with notes of how abundant the flow was and how much protection you needed to control it.

Your doctor will perform a physical check and may recommend one or more tests or procedures such as:

- Blood test. A sample of your blood is evaluated if excessive blood loss during menstruation has caused you anemia. Tests may also be recommended to check for thyroid gland dysfunction or abnormal accumulation of blood clots.

- Pap test. Your doctor collects cells in the cervix that will be examined microscopically to detect infections, inflammations or changes that can be cancerous or lead to cancer.

- Endometrial biopsy. Your doctor will take a tissue sample inside the uterus that will be examined under a microscope.

- Ultrasound examination. This imaging method uses sound waves to produce images of the uterus, ovaries and pelvis.
Based on the results of the initial tests, your doctor may recommend other tests, including:

- Sonohistogram. This ultrasound examination is performed after the fluid is injected into the uterus through a tube that is inserted into the vagina and cervix. This allows your doctor to check if the endometrium is healthy.

- Hysteroscopy. A small tube with a light is inserted into the uterus via the vagina and through the cervix, which allows the doctor to see the inside of the uterus.

- Dilation and curettage (D and C). During this procedure, the doctor opens (opens) the cervix and then inserts a spoon-shaped instrument into the uterus to collect tissue from the endometrium. This tissue is examined in the laboratory.

Doctors can be sure of the diagnosis of menorrhagia after having cleared up all the irregularities related to the menstrual cycle, medical conditions and medication as possible causes or aggravation of this condition.

Complications

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

- Iron deficiency anemia. In this type of anemia commonly encountered, your blood is low in hemoglobin, a substance that allows red blood cells to transport oxygen to tissues. The reduced amount of hemoglobin may be the result of insufficient iron.
Menorrhagia can lower the iron level far enough to increase the risk of iron deficiency anemia. Symptoms include pallor, weakness and fatigue.
Although diet plays an important role in iron deficiency anemia, the problem is complicated by abundant menstruation.
Most cases of anemia are mild, but even mild anemia can cause weakness and fatigue.
Moderate and severe anemia can also cause breathing problems, accelerated pulse, dizziness and headache.

- Severe pain. Abundant menstrual bleeding is often associated with menstrual cramps (dysmenorrhea). Sometimes the cramps associated with menorrhagia are severe and require medication or surgery.

Types of treatment

The specific treatment for menorrhagia is based on a number of factors including:

- Your general health and medical history;
- The cause and severity of the disease;
- Your tolerance for certain drugs, procedures or therapies;
- The probability that your menstruation will soon become less abundant;
- The effects of this condition on your lifestyle;
- Your opinion and personal preference.

Menorrhagia drug therapy may include:

- Iron supplements. If the condition is associated with anemia, your doctor may recommend that you take iron supplements regularly. If the level of iron in your body is low you are not yet anemic, you can start taking iron supplements instead of waiting to become anemic.

- Nonsteroidal anti-inflammatory drugs (MAINS). HANDS such as ibuprofen (Advil, Motrin, others) help reduce menstrual blood loss. BUT they still have a benefit, namely the improvement of painful menstrual cramps (dysmenorrhea).

- Oral contraceptives. In addition to being an effective contraceptive method, oral contraceptives can help regulate ovulation and reduce episodes of excessive or prolonged menstrual bleeding.

- Progesterone. Progesterone hormone can help correct hormonal imbalances and reduce menorrhagia. If menorrhagia arises from hormonal treatment, you and your doctor can treat the condition by changing or stopping the medication. You may need surgical treatment for menorrhagia if drug therapy does not pay off. Treatment options include:

- Dilation and curettage (D and C). During this procedure, the doctor opens (dilates) the cervix and then cleans or inhales the tissue in the endometrium to reduce menstrual bleeding. Although this procedure is used frequently and most often treats menorrhagia successfully, you may need additional D and C procedures if menorrhagia recurs.

- Operative hysteroscopy. This procedure uses a small tube with a light (hysteroscope) to see the uterine cavity and can help in the surgical removal of a polyp that could cause excessive menstrual bleeding.

- Endometrial ablation. Using ultrasonic energy, your doctor permanently destroys the entire endometrium. After endometrial ablation, most women have normal menstrual flow. However, some women have little or no flow after the procedure. Endometrial ablation reduces your ability to become pregnant.

- Endometrial resection. This surgical procedure uses an electrosurgical wire spring to remove the endometrium. Endometrial ablation and endometrial resection both benefit women who have very abundant menstrual bleeding, but who have no other underlying uterine problems such as large fibroids, polyps or cancer. Like endometrial ablation, this procedure reduces your ability to become pregnant.

- Hysterectomy. Surgical removal of the uterus and cervix is ​​a permanent procedure that causes sterility and cessation of menstruation.

You will need general anesthesia and hospitalization. Additional removal of the ovaries (total hysterectomy) can cause premature menopause in young women. Because hysterectomy is permanent, be sure you want this treatment before performing the procedure. Except for hysterectomy, after these surgical procedures patients do not require hospitalization. Although you need general anesthesia, it is very possible that you can go home the same day. When menorrhagia is a sign of another condition, such as thyroid disease, treating that condition usually results in less abundant menstruation.

Personal care

Here are some tips for treating menorrhagia at home:

- Rest as much as you need. Your doctor may recommend that you rest if the bleeding is excessive and disturb your regular schedule and lifestyle.

- Write it down. Write down the number of buffers you use so that the doctor can determine the extent of bleeding. Change the tampons regularly, at least once every 4-6 hours.

- Avoid aspirin. As aspirin promotes the formation of blood clots you should avoid it. Ibuprofen (Advil, Motrin, others) are often more effective than aspirin in relieving menstrual discomfort.

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