Menorrhagia

Menorrhagia

Menorrhagia is a medical term to describe excessive amounts of blood coming out during menstruation or periods that last more than 7 days. If left untreated, menorrhagia can lead to impaired quality of life up to anemia.

During menstruation , the amount of blood that is still considered normal is around 30-40 ml per cycle. A woman is considered to have excessive menstruation if the amount of blood released is more than 80 ml or about 16 teaspoons per cycle.

One way that can be done to determine menstrual disorders is to be aware of how often to change pads. If the change of pads full of blood is done less than once every 2 hours, then this condition can be a sign that a woman is experiencing menorrhagia.

Causes of Menorrhagia

There are several conditions that generally trigger menorrhagia, namely:

  • Hormonal disorders, for example due to polycystic ovary syndrome , obesity, hypothyroidism , and insulin resistance
  • Disorders or growth of tissue in the uterus, such as pelvic inflammation, myoma (uterine fibroids), endometriosis , adenomyosis, and uterine polyps
  • Disorders of the ovaries, which cause the ovulation process not to occur as it should
  • Genetic disorders, especially those that affect the blood clotting process, such as von Willebrand's disease
  • Side effects of drugs, such as anti-inflammatory drugs, hormonal drugs, anticoagulants , chemotherapy drugs, and herbal supplements containing ginseng, ginkgo biloba and soybeans
  • Contraceptives, such as birth control pills and spiral birth control ( IUD )
  • Cancer, such as uterine cancer or cervical (cervical) cancer

Menorrhagia symptoms

Menstruation is the process of shedding the uterine lining which is marked by the discharge of blood from the vagina. Normally, the menstrual cycle occurs every 21-35 days, starting from the day of the last menstrual period and lasts 4-7 days. While the amount of blood that comes out is 30-40 ml or about 6-8 teaspoons.

In menorrhagia sufferers, menstruation occurs for more than 7 days and the amount of blood that comes out exceeds the normal amount.

Some of the common symptoms of menorrhagia are:

  • Replacement of blood-filled sanitary napkins is done in less than 2 hours
  • Menstruation lasts more than 7 days
  • Get up from sleep at night to change pads
  • The blood that came out was accompanied by blood clots the size of a coin
  • Pain in the lower abdomen
  • The blood that comes out is too much so that it interferes with daily activities

When to see a doctor

Check with your doctor if you experience any of the symptoms mentioned above, especially if these symptoms interfere with your daily activities. You are also advised to immediately see a doctor if you experience the following complaints during menstruation:

  • Dizzy
  • Severe abdominal pain
  • Lots of blood clots coming out
  • Chest pain
  • Hard to breathe
  • Faint

Diagnosis of Menorrhagia

The doctor will conduct questions and answers about the symptoms experienced, the patient's medical history, and how often the patient changes pads or tampons during menstruation. Furthermore, in order to confirm the diagnosis of menorrhagia, the doctor will recommend further examinations, such as:

  • Blood tests , to detect anemia , thyroid hormone disorders, or blood clotting disorders
  • Pap smear , which is the examination of a tissue sample from the inner wall of the cervix to check for signs of inflammation, infection, or the potential for cancer
  • Biopsy , namely taking tissue samples from the uterus to be examined under a microscope
  • Ultrasound of the uterus, which is a scan to check if there are fibroids, polyps, or other abnormalities
  • Sonohysterography (SIS), which is an examination by injecting dye into the uterus to detect disorders in the lining of the uterine wall
  • Hysteroscopy , which is an examination by inserting a thin camera tube through the vagina to see the condition of the patient's uterus
  • Dilatation and curettage (curette), which is examination of a sample of the uterine wall to determine the cause of bleeding

Menorrhagia Treatment

Treatment for menorrhagia depends on the underlying cause and the severity of the patient's condition. The doctor will also consider the patient's age, general health condition, and whether the patient is still planning to become pregnant.

The following are several treatment methods that can be given to menorrhagia sufferers:

Drugs

Types of drugs that can be given by doctors to treat menorrhagia are:

  • Antifibrinolytic drugs, such as tranexamic acid , to help the blood clotting process
  • Non-steroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen, naproxen, and mefenamic acid, to relieve pain symptoms and reduce the production of prostaglandins that can trigger menorrhagia
  • Combined contraceptive pills , to regulate the cycle and reduce the length of menstruation, as well as the amount of blood that comes out during menstruation
  • Desmopressin, to treat the causes of bleeding in von Willebrand's disease
  • Injectable progestogen and oral norethisterone (oral medication), to help balance hormone levels and reduce bleeding
  • GnRH-a analogue (gonadotropin releasing hormone analogue), to reduce bleeding during menstruation, improve the menstrual cycle, reduce the risk of pelvic inflammation, and prevent cancer
  • Iron , for menorrhagia sufferers who experience anemia

In cases of menorrhagia with heavy bleeding causing severe anemia, the patient will be advised to undergo hospitalization. The doctor will give the patient a blood transfusion .

Operation

Surgical procedures may be recommended by doctors if menorrhagia cannot be treated with medication. The types of operations that can be performed include:

  • Dilatation and curettage (D&C)
    The doctor will dilate the cervix and scrape the uterine wall to reduce bleeding during menstruation.
  • Uterine artery embolization Uterine
    artery embolization is performed to treat menorrhagia caused by myoma. In this procedure, the fibroids are shrunk by blocking the arteries that supply blood to the fibroids.
  • Myomectomy
    Through this procedure, the myoma which is the cause of excessive menstruation will be surgically removed . Depending on the size, number, and location of myomas, there are two types of myomectomy that can be performed to treat menorrhagia, namely laparoscopic and hysteroscopic.
  • Removal (resection) of the endometrium
    This procedure is performed to remove the endometrium using a special wire that has been heated. After undergoing endometrial resection, the patient is not recommended to become pregnant.
  • Endometrial ablation
    This procedure is performed by permanently destroying the endometrial lining, either using a laser, radiofrequency (RF), or by heating.
  • Hysterectomy This
    surgical removal of the uterus will stop menstruation forever and prevent the patient from becoming pregnant. Usually, the hysterectomy procedure is taken if menorrhagia can no longer be treated in other ways.

Menorrhagia complications

Heavy or long-term menstrual bleeding can cause health complications in the form  of iron deficiency anemia , which is characterized by headaches, dizziness, shortness of breath, and palpitations.

Menorrhagia can also cause menstrual pain ( dysmenorrhea ) that is so severe that it requires medical treatment.

Prevention of Menorrhagia

Menorrhagia can be caused by a variety of conditions, making it difficult to prevent. The best way that can be done is to undergo regular checks with the doctor if there are factors that increase the risk of developing menorrhagia. That way, doctors can take action earlier if you experience excessive menstruation.

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