In a normal menstrual cycle, the average woman loses a total of 30-40 ml of blood over three to seven days. Heavy or prolonged menstrual bleeding is known as menorrhagia.
Research criteria defines this narrowly as a monthly menstrual blood loss in excess of 80 ml. A more practical definition may be that of menstrual loss that is greater than the woman feels she can reasonably manage. The National Institute for Health and Clinical Excellence (NICE) in the UK defines heavy menstrual loss as excessive blood loss that interferes with a woman’s physical, social, emotional and/or quality of life.
Menorrhagia is a common problem in clinical practice that can have adverse effects on the quality of life for many women.
You may be experiencing menorrhagia if you have the following:
Causes of menorrhagia include :
During consultation, your doctor will ask questions and perform an examination to try to determine the cause of the heavy menstrual bleeding.
Important information that you may provide to the doctor during the consultation include:
Clinical examination will be undertaken to assess for any anaemia and also to rule out potential organic causes of menorrhagia. This usually includes a pelvic examination.
Tests that may be carried out include:
A full blood picture will give an estimation of the degree of anaemia (low blood count). Other blood tests such as thyroid function tests and bleeding disorder testing may be performed if your doctor suspects a disorder.
The important conditions to rule out first include pregnancy, endometrial hyperplasia (abnormal thickening of the lining of the womb) and endometrial carcinoma.
If there are organic causes of menorrhagia, such as fibroids or adenomyosis, treatment options can be offered based on your wishes and fertility concerns.
If there is suspected chronic endometritis (risk factors include recent childbirth or intrauterine procedure), this can often be treated with a course of antibiotics.
If you are found to be anaemic, iron supplementation is usually recommended.
The general considerations guiding the choice of initial treatment are:
In the absence of any structural or histological abnormalities, or fibroids more than 3 cm causing distortion of uterine cavity, the recommendations for treatment are:
This may be considered also if you are close to menopause and other treatments are not working or contraindicated.
The choice of treatment will depend on both the uterine size and the patient’s desire to retain her uterus.