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MENORRHAGIA: HEAVY MENSTRUAL BLEEDING CAUSES AND TREATMENTS

Oheneba Kwakye Omane
Oheneba Kwakye Omane

Did you know that more than 75,000 hysterectomies (removal of the uterus) are carried out every year? And out of these surgeries, nearly 30% are mandated by menstrual cycle disturbances. And that heavy periods is one of the most serious menstrual cycle complaints that lead to hysterectomy? Heavy menstrual flow is not a disease in itself and it is a common menstrual health symptom that is observed in multiple gynaecological disorders such as endometriosis, fibroids, hormone imbalances, thyroid dysfunction and many more. Chronic and extreme cases of heavy periods put the health of women at risk. Heavy menstrual bleeding affects the health of women at all levels including physical, mental, emotional and social. Heavy Periods refers to monthly menstrual bleeding which is excessive in the quantity of bleeding during the periods and or happens in the form of an extended menstrual cycles with heavy bleeding. It is termed Menorrhagia in medical terms.

Some notable facts:

According to Hallberg and Nilsson, the World Health Organization reports that 18 million women aged 30-55 years perceive their menstrual bleeding to be exorbitant.
Medical data indicates nearly 30% of women of reproductive age have reported heavy bleeding at some point.
Out of these, 10% of the women experience severe blood loss that leads to anaemia and is clinically defined as Menorrhagia.


What is menorrhagia?

Menorrhagia is the most common type of abnormal uterine bleeding. It is characterized by heavy and prolonged menstrual bleeding. In some cases, bleeding may be so severe and relentless that daily activities become interrupted. Other types of abnormal uterine bleeding (also called dysfunctional uterine bleeding) include:

  • Polymenorrhea-- Too frequent menstruation.
  • Oligomenorrhea-- Infrequent or light menstrual cycles.
  • Metrorrhagia-- Any irregular, acyclic non-menstrual bleeding from the uterus and bleeding between menstrual periods.
  • Postmenopausal bleeding-- Any bleeding that happens more than one year after the last normal menstrual period at menopause.


What causes menorrhagia?

There are several possible causes of menorrhagia, including the following:

  • Hormonal (particularly estrogen and progesterone) imbalance (especially seen in adolescents who are experiencing their first menstrual period. Also in women approaching menopause)
  • Pelvic inflammatory disease
  • Uterine fibroids
  • Abnormal pregnancy (such as miscarriage or ectopic)
  • Infection, tumours, or polyps in the pelvic cavity
  • Certain birth control devices (such as intrauterine devices or IUDs)
  • Bleeding or platelet disorders
  • High levels of prostaglandins. These are chemical substances that help to control the muscle contractions of the uterus.
  • High levels of endothelins. These are chemical substances that help the blood vessels in the body dilate.
  • Liver, kidney, or thyroid disease

What are the symptoms of menorrhagia?

In general, bleeding is considered excessive when a woman soaks through enough sanitary products (sanitary napkins or tampons) to warrant changing every hour. In addition, bleeding is considered prolonged when a woman experiences a menstrual period that lasts longer than 7 days. However, each individual may experience symptoms differently. Symptoms may include a burning sensation in the lower portion of the groin, pelvic region, and back region of the kidney. Severe pain in the uterus may also accompany heavy vaginal bleeding. Additional symptoms include:

  • Excessive Menstrual Bleeding, more than 80 ml per cycle.
  • Passage of blood clots
  • Prolonged menstrual flow, more than 7 days
  • Pain in the lower back portion and lower abdomen
  • Pain in multiple body parts and lack of energy
  • Pain in the hypogastric region (central part of the abdomen)
  • Weakness, Fatigue, Giddiness, and Inability to do usual work
  • Anemia
  • Palpitations and shortness of breath
  • Heavy menstrual flow leads to blood loss, resulting in Anemia and its trailing symptoms.
  • Giddiness, extreme fatigue, severe backache, weakness, oedema, and congestive heart failure usually accompany resulting in fainting or loss of consciousness in multiple cases.
  • Menorrhagia also increases susceptibility to peripheral infections and local infections as bacterial vaginosis.
  • Spotting or bleeding between menstrual periods
  • Spotting or bleeding during pregnancy

The symptoms of menorrhagia may resemble other menstrual conditions or medical problems. Always talk with your healthcare provider for a diagnosis.

How is menorrhagia diagnosed?

Diagnosis begins with a healthcare provider evaluating a woman’s medical history and a complete physical exam including a pelvic exam. A diagnosis of menorrhagia can only be certain when the healthcare provider rules out other menstrual disorders, medical conditions, or medicines that may be causing or aggravating the condition. Other diagnostic procedures for menorrhagia may include the following:

  • Blood tests
  • Pap test. A test that involves a microscopic exam of cells collected from the cervix. A Pap test is used to find changes that may be cancerous or may lead to cancer, and to show noncancerous conditions. These include an infection or inflammation.
  • Ultrasound (also called sonography)
  • Biopsy (endometrial)-- A procedure in which tissue samples are removed (with a needle, pipette, brush, or during surgery) from the body to be examined under a microscope. It is also to determine if cancer or other abnormal cells are present. An endometrial biopsy removes tissue from the lining of the uterus.
  • Hysteroscopy-- A visual exam of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope). The hysteroscope is inserted through the vagina.
  • Dilation and curettage (D & C)-- A common gynaecological surgery. It consists of widening the cervical canal with a dilator and scraping the uterine cavity with a curette.

Treatment for menorrhagia

Specific treatment for menorrhagia will be discussed with you by your healthcare provider based on:

  • Your age, overall health, and medical history
  • Extent of the condition
  • Cause of the condition
  • Your tolerance for specific medicines, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

Treatment for menorrhagia may include:

  • Iron supplementation-- This treatment is used if the condition is coupled with anaemia. This is a blood disorder caused by a deficiency of red blood cells or haemoglobin.
  • Prostaglandin inhibitors-- These are nonsteroidal anti-inflammatory medicines, including aspirin or ibuprofen. They help reduce cramping and the amount of blood expelled.
  • Oral contraceptives-- These inhibit ovulation.
  • Progesterone-- Hormone treatment.
  • Endometrial ablation-- A procedure to destroy the lining of the uterus (endometrium).
  • Endometrial resection-- A procedure to remove the lining of the uterus (endometrium).
  • Hysterectomy-- A surgical removal of the uterus.


Some diet and lifestyle tips..

It cannot be disputed that menorrhagia could also happen as a result of bad lifestyle choices and eating habits. Excessive consumption of salty, sour, hot, spicy, and heavy to digest foods could result in heavy bleeding during the menstrual cycle. Some lifestyle changes that could contribute immensely to curbing menorrhagia are:

  • Consumption of iron-rich foods.
  • No Alcohol.
  • Avoid Caffeine.
  • Drink plenty of fluids.
  • Include herbs and spices such as cardamom, cinnamon, fennel, cumin, and basil.
  • Inclusion of foods such as bitter gourd, pointed gourd, squashes, green leafy vegetables, and cruciferous vegetables
  • Avoiding excessive stress, irregular sleep patterns, emotional distress involving trauma.
  • Avoid excessive physical activity and exposure to the Sun.
  • Apply ice-pack to lower abdomen during menstruation.
  • Follow the circadian rhythm. Sleep early and get enough sleep (7-8 hours every day).
  • No Smoking.



References

  1. 20 Home Remedies For Menorrhagia (Heavy Bleeding) - Boldsky.com. Retrieved from https://www.boldsky.com/amphtml/health/disorders-cure/2019/home-remedies-for-menorrhagia-heavy-bleeding-063596.html

2. Hallberg, L., & Nilsson, L. (1964). Determination of menstrual blood loss. Scandinavian Journal of Clinical and Laboratory Investigation, 16(2), 244-248.

3. Heavy Periods Diet and Lifestyle Tips - Ayurvedic Self-Care (medhyaherbals.com) Retrieved from https://medhyaherbals.com/menorrhagia-heavy-periods/

Oheneba Kwakye Omane

Health Enthusiast and Futurist