What is menorrhagia?
Menorrhagia can be caused by many disorders: anatomic abnormalities of the uterus, hormonal imbalances, certain medical conditions, medications, and malignancy. Common anatomic causes are uterine fibroids and adenomyosis. Irregular menstrual cycles resulting from hormonal imbalances can be associated with menorrhagia. Medical conditions such as blood clotting disorders and liver or thyroid disease contribute to menorrhagia. Medications that prevent blood clotting, such as coumadin or heparin, can lead to increased menstrual flow. Uterine and other reproductive tract cancers can result in unusually heavy menstrual flow.
Symptoms of menorrhagia are uterine bleeding that is excessive (more than 80 milliliters) and/or bleeding that lasts for more than seven days. Unlike metrorrhagia, bleeding occurs at regular intervals. The patient can become anemic and exhibit symptoms of either acute or chronic blood loss. Symptoms and signs which suggest the cause of menorrhagia may be present, such as large palpable fibroids, or evidence of hypothyroidism or liver disease.
Menorrhagia can be treated via a medical or a surgical approach. The selection of treatment often depends on the cause and severity of the menorrhagia. If menorrhagia is the result of conditions amenable to medical treatment (such as a thyroid disorder), then control of these conditions may decrease the bleeding. If the patient has irregular cycles (for example, because of lack of ovulation), then hormones such as oral contraceptive pills or medroxyprogesterone may be used to regulate the cycles and decrease menstrual flow. A patient who is nearing the menopause can receive hormone injections that place her into an earlier artificial menopause, and hence eliminate menstrual bleeding altogether. If the patient encounters acute and profuse bleeding, then high-dose estrogens may be given.
If menorrhagia is resistent to medical management, then surgical treatment may be necessary. Examples of procedural treatments for menorrhagia are dilation and curettage (D & C), for acute, profuse bleeding; thermal ablation of the endometrial lining; hysteroscopic resection of endometrial polyps or fibroids; and placement of a progesterone-impregnated intrauterine device (IUD). Hysterectomy is the definitive surgery for menorrhagia, no matter what the cause, since menstrual bleeding cannot occur without the uterus. Patients with large fibroids or adenomyosis often are not responsive to medical management. These patients would be candidates for hysterectomy. In patients with large fibroids and menorrhagia who wish to retain childbearing potential, a myomectomy may be performed instead of hysterectomy. If a patient is suspected or known to have a malignancy of the reproductive tract that is causing menorrhagia, then surgical management is the appropriate treatment.
Finally, patients can become severely anemic from menorrhagia, and blood transfusion may be necessary. Mild anemia can be treated with iron supplementation.
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