Heavy Menstrual Bleeding: Sign, Symptom, Cause, Diagnosis And Treatment

Menorrhagia (Abnormal Uterine Bleeding) is an abnormal menstrual period in its quantity, timing or duration of bleeding.Bleeding excessively can cause anemia that presents fatigue, weakness, and shortness of breath.

Menstruation (Monthly) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina.The first period usually begins twelve years old and fifteen yearls old.It is also considered normal if the first period in eight years old.Bleeding usually lasts around two to seven days.The typical length of time between the first day of one period and the first day of the next is 21 to 45 days in young women and  21 to 31 days in adults (about 28 days).The menstrual cycle occurs due to the rise and fall of hormones.The menstrual cycle is the monthly series of changes a woman's body goes through in preparation for the possibility of pregnancy.The menstrual cycle is different for every women.Blood flow averages about four or five days with a blood loss of about 40 cc or 3 tablespoon.The Common Symptoms of Menstruation, such as acne, mood changes, tender breasts, irritability, feeling tired, and bloating

The Signs or Symptoms of Menorrhagia

• Blood loss about 80 cc or 5 tablespoon.
• Bleeding for longer than a week.
• Soaking through one or more sanitary pads or tampons every hour for several consecutive hours.
• Needing to use double sanitary protection to control menstrual flow.
• Passing blood clots with menstrual flow for more than one day.
• Pale skin.
• Fatigue or tiredness.
• Shortness of breath.

The Causes of Menorrhagia

• Hormone imbalance occurs in which the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding.
• Uterine fibroids can cause heavier bleeding than normal or prolonged menstrual bleeding.
• Adenomyosis occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding and painful menses.
• Dysfunction of the ovaries.The ovaries do not release an egg during a menstrual cycle.
• Polyps are small, benign growths on the lining of the uterus (uterine polyps) that may cause heavy and prolonged menstrual bleeding.
• Intrauterine device (IUD) is the cause of mentrual bleeding excessively.
• Inherited bleedibg disorder.
• Pregnancy complication.
• Cancer includes ovariam cancer, cervical cancer, and uterine cancer can cause excessive menstrual bleeding.
• Medications include anti-inflammatory drugs and anticoagulants can contribute heavy and prolonged menstrual bleeding.

Diagnosis

There are some tests and procedured to diagnose the cause of abnormal uterine bleeding.

• Complete Medical History.
• Physical Examination.
• Pelvic and Rectal Examination is to ensure that bleeding is not from lower productive tract or rectum.
• Pap Smear is to rule out cervical neoplasia.
• Pelvic Ultrasound Scan is the first line diagnostic tool for identifying structural abnormalities.
• Endometrial Biopsy is to exclude endometrial cancer or atypical hyperplasia.
• Sonohysterogram
• Laboratory test or Hysteroscopy.

Treatment of Menorrhagia

• Intrauterine System (IUS)
• Medications include Non-Steroidal anti-inflammatory drugs, Tranexamic Acid tablets, aminocaproic acid.
• Hysterectomy is removal of the uterus.
• Myomectomy is local removal.
• Endometrial Ablation (Destruction) is surgical tehnique by the use of applied heat (Thermoablation).

Surgery

• Dilation and Curettage is a procedure that reduces menstual bleeding.
• Endometrial Ablation
• Uterine Artery Embolisation (UAE)
• Hysteroscopic Myomectomy is to remove fibroids over 3 centimeters in diameter.

Medications For Menorrhagia

1. First Line

• Intrauterine device with progesterone.

2. Second Line

• Tranexamic Acid is an antifibrinolytic agent to reduce the amount of bleeding.
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Combined Oral Contraceptive Pills are to prevent proliferation of the endometrium.

3. Third Line

• Oral Progestogen, such as Norethisterone is to prevent proliferation of the endometrium.
• Injected Progestogen, such as Depo Provera.

4. Other options

• Gonadotropin-Releasing Hormone Agonist.