The causes and complications of menorrhagia and how to stop or treat heavy menstrual bleeding.

What is menorrhagia?

Menorrhagia, also known as prolonged bleeding or heavy menstrual periods, varies for each woman, so it may be difficult to tell what’s normal and what’s abnormal bleeding.

Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding. Although heavy menstrual bleeding is a common concern, most women don't experience blood loss severe enough to be defined as menorrhagia.

Heavy menstruation is a common complaint that affects one in three women as they approach the menopause and Doctors say that normal menstrual bleeding is a period that lasts from three to seven days; while prolonged menstrual bleeding is defined as bleeding that goes beyond a week.

With menorrhagia, you can't maintain your usual activities when you have your period because you have so much blood loss and cramping. If you dread your period because you have such heavy menstrual bleeding, talk with your doctor. There are many effective treatments for menorrhagia.

Symptoms

Signs and symptoms of menorrhagia may include:

• Soaking through one or more sanitary pads or tampons every hour for several consecutive hours
• Needing to use double sanitary protection to control your menstrual flow
• Needing to wake up to change sanitary protection during the night
• Bleeding for longer than a week
• Passing blood clots larger than a quarter
• Restricting daily activities due to heavy menstrual flow
• Symptoms of anemia, such as tiredness, fatigue or shortness of breath
• depressed or moody, are signs that the excessive bleeding has reduced the amount of iron in the blood.

Causes of menorrhagia.

In some cases, the cause of heavy menstrual bleeding is unknown, but a number of conditions may cause menorrhagia. Common causes include:

• Hormone imbalance. In a normal menstrual cycle, a balance between the hormones estrogen and progesterone regulates the buildup of the lining of the uterus (endometrium), which is shed during menstruation. If a hormone imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding.
  A number of conditions can cause hormone imbalances, including polycystic ovary syndrome (PCOS), obesity, insulin resistance and thyroid problems.
• Dysfunction of the ovaries. If your ovaries don't release an egg (ovulate) during a menstrual cycle (anovulation), your body doesn't produce the hormone progesterone, as it would during a normal menstrual cycle. This leads to hormone imbalance and may result in menorrhagia.
• Uterine fibroids. These noncancerous (benign) tumors of the uterus appear during your childbearing years. Uterine fibroids may cause heavier than normal or prolonged menstrual bleeding.

• Polyps. Small, benign growths on the lining of the uterus (uterine polyps) may cause heavy or prolonged menstrual bleeding.
• Adenomyosis. This condition occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding and painful periods.
• Intrauterine device (IUD). Menorrhagia is a well-known side effect of using a nonhormonal intrauterine device for birth control which is placed in the uterus, can also cause heavier menstrual bleeding than normal, especially during the first year of use, in older women, especially in post menopause women.. Your doctor will help you plan for alternative management options.
• Pregnancy complications. A single, heavy, late period may be due to a miscarriage. Another cause of heavy bleeding during pregnancy includes an unusual location of the placenta, such as a low-lying placenta or placenta previa.
• Cancer. Uterine ( endometrial) cancer and cervical cancer can cause excessive menstrual bleeding, especially if you are postmenopausal or have had an abnormal Pap test in the past.
• Inherited bleeding disorders. Some bleeding disorders such as von Willebrand's disease, a condition in which an important blood-clotting factor is deficient or impaired can cause abnormal menstrual bleeding.
• Medications. Certain medications, including anti-inflammatory medications, hormonal medications such as estrogen and progestins, and anticoagulants such as warfarin (Coumadin, Jantoven) or enoxaparin (Lovenox), can contribute to heavy or prolonged menstrual bleeding.
• Other medical conditions. A number of other medical conditions, including liver or kidney disease, may be associated with menorrhagia.

When to see a doctor

Seek medical help before your next scheduled exam if you experience:

• Vaginal bleeding so heavy it soaks at least one pad or tampon an hour for more than two hours
• Bleeding between periods or irregular vaginal bleeding
• Any vaginal bleeding after menopause

Treatment of menorrhagia.

The treatment depends on the cause; specific treatment is based on the number of factors which could include overall health and medical history, for instance, the capacity of a patient to tolerate some specific medication or therapies and most importantly, the patient’s preferences when it comes to child-bearing plans.

Some of the medication given includes; tranexamic acid; this helps to reduce excessive blood loss, oral contraceptives known as combined oral contraceptive pills, these help regulate menstrual cycles and reduce the episodes of prolonged and excessive bleeding.

Mirena intrauterine devices reduce the menstrual flow and cramping, if menorrhagia has caused anaemia, it is advised  that you take iron supplements.

Myomectomy can also be done; this is an operation to remove fibroids while preserving the uterus.

Hysteroscopic morcellation: A hysteroscope is inserted into the womb through the cervix and an instrument called a morcellator is used to cut or “shave” away small abnormalities, such as polyps.

Endometrial ablation: This destroys the womb lining with either laser, heat or ultrasound energy. It can be performed as a day case and usually takes just 15 minutes. Most women have no periods afterwards.

Uterine artery embolisation: This treats fibroids and involves inserting a small tube into the groin to block the blood vessels supplying blood to the fibroid.

Hysterectomy: A 100% effective procedure to remove the womb. It can be done vaginally, by keyhole surgery or by a surgical cut, which requires a hospital stay.

Other medications that can reduce on the bleeding, include, ibuprofen, non-steroid anti-inflammatory drugs (NSAIDs) such as  mefenamic acid  that reduces blood loss by around 20% while also alleviating pain., among other treatment.

Self-help tip for heavy periods

Incorporating plenty of magnesium-rich foods into your diet. These include dark leafy veg, nuts, seeds, beans and wholegrains. Magnesium is excellent for heavy periods and it acts as a gentle muscle relaxant so it can help take the edge off very strong contractions of the uterus which can give rise to very heavy periods.

Risk factors

Risk factors vary with age and whether you have other medical conditions that may explain your menorrhagia. In a normal cycle, the release of an egg from the ovaries stimulates the body's production of progesterone, the female hormone most responsible for keeping periods regular. When no egg is released, insufficient progesterone can cause heavy menstrual bleeding.

Menorrhagia in adolescent girls is typically due to anovulation. Adolescent girls are especially prone to anovulatory cycles in the first year after their first menstrual period (menarche).

Menorrhagia in older reproductive-age women is typically due to uterine pathology, including fibroids, polyps and adenomyosis. However, other problems, such as uterine cancer, bleeding disorders, medication side effects and liver or kidney disease must be ruled out.

Complications

Excessive or prolonged menstrual bleeding can lead to other medical conditions, including:

• Anemia. Menorrhagia can cause blood loss anemia by reducing the number of circulating red blood cells. The number of circulating red blood cells is measured by hemoglobin, a protein that enables red blood cells to carry oxygen to tissues.
  Iron deficiency anemia occurs as your body attempts to make up for the lost red blood cells by using your iron stores to make more hemoglobin, which can then carry oxygen on red blood cells. Menorrhagia may decrease iron levels enough to increase the risk of iron deficiency anemia.
  Signs and symptoms include pale skin, weakness and fatigue. Although diet plays a role in iron deficiency anemia, the problem is complicated by heavy menstrual periods.
• Severe pain. Along with heavy menstrual bleeding, you might have painful menstrual cramps (dysmenorrhea). Sometimes the cramps associated with menorrhagia are severe enough to require medical evaluation.