What is menorrhagia in women. Menorrhagia (heavy menstruation). Symptoms and diagnosis of the disease

Menorrhagia is the medical term for heavy periods. In a study based on counting pads and tampons, it was shown that on average a woman loses 35 ml of blood per menstruation. Menorrhagia is defined as the loss of more than 80 ml of blood (above the 90th percentile).

How often does it occur?

In population studies, it has been shown that 10% of menstruating women lose more than 80 ml of blood. More recently, it has been found that a woman's subjective assessment of blood loss correlates better with measured blood loss than previously thought.

How common is menorrhagia in general practice?

Approximately 5% of women aged 30-49 seek help from their GP because of heavy bleeding. Therefore, menorrhagia is a condition that a general practitioner must be able to treat effectively. This is also important because, until recently, the risk of hysterectomy (primarily due to menstrual disorders) at reproductive age was 20%.

What should women know about menorrhagia and how can a doctor help them?

An interesting study has recently been done on how women themselves perceive menorrhagia, how they understand the mechanism of its occurrence and what kind of help they expect from medical professionals. The results of a survey of women who turned to their general practitioner about "heavy periods" were evaluated. The researchers found that women had a fairly specific understanding of their symptoms. Changing the cycle itself was already regarded by many women as a problem, without additional criteria. Women paid special attention to how they feel, how efficient they are, but they were not enthusiastic about the doctor's suggestion to measure the amount of blood loss. Many of the women were disappointed with the GP's consultation and felt that he had missed the point of their problem. Women were looking for explanations of the reasons for the change in their cycle and did not fully understand what constituted menstrual bleeding. The respondents were not sure whether their problem should be considered a disease and what level of discomfort should be considered normal.

The physician should consider blood loss to be excessive if it reduces the physical, emotional, social and material quality of life, regardless of the presence of other symptoms. Accordingly, any intervention should be aimed at improving the quality of life.

Diagnosis of menorrhagia in women

What is the tactics of a doctor in a woman who complains of heavy menstruation?

A recent evidence-based guideline has proposed a novel approach to the management of severe menstrual blood loss in the general practice setting.

This algorithm assumes that the general practitioner as a first step:

guess the nature of the bleeding;
evaluate symptoms that may indicate anatomical or histological abnormalities;
evaluate the impact on quality of life, as well as other factors that may determine therapy (for example, the presence of comorbidities).

What are the key points to be clarified when taking an anamnesis in a patient who complains of heavy menstruation?

First of all, the degree of blood loss should be determined. It can be difficult for women to measure it. Instead of measuring blood loss by counting pads, a GP can identify "indicators" by asking the following questions:

How many tampons or pads do you use per day?
Do you have blood clots?
Have you ever used both a tampon and a pad and still worry about the possibility of a leak?
Did you have the feeling that the blood is being released in a continuous stream?

Blood clots, the feeling of flowing blood, and the need to use pads and tampons are both good indicators of menorrhagia.

After that, it is important to find out how regular the bleeding is. This will tell if the bleeding is related to the ovulatory or anovulatory cycle, in which dysfunctional uterine bleeding may have occurred. In women aged 36-50 years, heavy menstruation usually occurs against the background of the ovulatory cycle and is caused by myomatous nodes. 80-90% of women with heavy menstrual bleeding have regular cycles (lasting 21-35 days). In women with prolonged irregular or intermenstrual bleeding, 25-50% of cases have submucosal myomatous nodes or endometrial polyps (assessment was carried out in carefully selected patients). The incidence of submucosal nodules and polyps in women with regular heavy menses is unknown.

Irregular and intermenstrual bleeding, unlike regular, often indicates the presence of pathological changes.

Very rarely, bleeding disorders can be the cause of menorrhagia. However, laboratory studies have shown that women with menorrhagia have increased fibrinolytic activity and increased production of prostaglandins in the endometrium. These observations formed the basis for the introduction of some new approaches to the treatment of menorrhagia.

At the third stage, you should find out how the symptoms affect the woman's daily life. Is she coping with work, family life, and day-to-day worries during her period? Does she have to constantly make sure that there is a toilet or bathroom nearby, which she has to visit because of the bleeding? The answers to these questions will allow the general practitioner to understand how urgent the situation is.

Ultimately, the general practitioner must assess the likelihood of anemia. In Western countries, menorrhagia is the main cause of iron deficiency and anemia. Therefore, a decrease in hemoglobin concentration objectively reflects the severity of blood loss during menstruation.

What data of the anamnesis allow the doctor to suspect the presence of a pathology?

Structural abnormalities of the uterus, such as endometrial polyps, adenomyosis, and leiomyomatosis, are the most well-known causes of excessive uterine bleeding. The doctor should be alert to the features of the anamnesis, indicating the presence of organic pathology and malignant neoplasms, and remember that the risk of endometrial cancer begins to increase after 40 years.

Risk factors for endometrial hyperplasia in premenopause include:

infertility or lack of pregnancy;
exposure to excess endogenous estrogens or exogenous estrogens/tamoxifen;
PCOS;
obesity;
a family history of endometrial or colon cancer.

The risk of hyperplasia and endometrial cancer with heavy menstrual bleeding is:

4.9% in all women;
2.3% in women under 45 and weighing less than 90 kg;
13% in women weighing over 90 kg;
8% in women over 45.

If a woman has no history of risk of anatomical or histological pathology, then at the first visit, medication can be prescribed without the need for physical or other examinations. An exception would be the insertion of a LV-IUS or a scheduled cervical Pap smear. If there is a history of heavy menstrual bleeding associated with intermenstrual or postcoital bleeding, pelvic pain, dyspareunia, and/or symptoms of tension, a physical examination and/or other investigations (eg, ultrasound) should be performed to rule out malignancy and other abnormalities .

When should the doctor conduct an examination?

Many, remembering the old adage “what you don’t look for, you won’t find,” recommend that all women with menorrhagia have a pelvic exam.

NICE guidelines state that an inspection is necessary if:

if the general practitioner believes that there is an indication of a possible pathology in the anamnesis;
if a woman decides to install a LV-IUD (examination is necessary to assess the possibility of placing a spiral in the uterus);
if the woman is referred for further examination, such as an ultrasound or biopsy.

If a woman has palpable fibroids through the abdominal wall, or is determined in the uterine cavity during ultrasound or hysteroscopy, and / or the length of the uterine body is more than 12 cm, she should be immediately sent for a consultation with a specialist.

What laboratory tests should a doctor order for a woman with menorrhagia?

Since there are many different research methods, one should carefully approach their appointment and remember that in 40-60% of women the cause of menorrhagia cannot be detected (in such cases, uterine bleeding is regarded as dysfunctional (unexplained etiology)).

The clinical manifestations of anemia do not correlate with the level of hemoglobin, except for moderately severe and severe cases. Therefore, all women with heavy menstruation should perform a complete blood count to further assess the severity of blood loss. Routine determination of iron levels is not recommended because hematological indices usually provide a good indication of the status of iron stores. Women with severe anemia are more likely to be affected and should be referred to a specialist immediately. Tests for coagulopathy should only be performed if heavy menstruation has bothered the woman since menarche, and if there has been a personal or family history of coagulation disorders. Assessing the level of female hormones is not justified. The study of the level of thyroid hormones is indicated only in the presence of signs of thyroid disease.

Recommendations for Common Lab Tests for Menorrhagia

All women with menorrhagia should have a complete blood count. In parallel, treatment of menorrhagia should be prescribed.
Testing for coagulopathy (eg, von Willebrand disease) should be considered in women with menorrhagia since menarche and if there is a personal or family history of coagulation disorders.
Serum ferritin measurement should not be routinely administered to all women with menorrhagia.
Women with menorrhagia should not be ordered to study the level of female sex hormones.
The study of the level of thyroid hormones is indicated only in the presence of signs of thyroid disease.
In the case of menorrhagia, the serum ferritin level does not provide more information than can be obtained from a complete blood count.

What is the role of ultrasound in the examination of a woman with heavy bleeding?

There is strong evidence in favor of ultrasound as the primary method for detecting structural abnormalities. It is a non-invasive and painless method of choice for women who need additional testing. With the help of ultrasound, it is possible to determine the thickness of the endometrium (in premenopausal women, the normal range is 10-12 mm), to identify polyps and nodes.

There is strong evidence to support the use of transvaginal ultrasonography as the primary diagnostic tool in the evaluation of women with menorrhagia.

This examination should be carried out if:

if the uterus is palpated through the abdominal wall;
if a vaginal examination reveals a formation in the pelvic cavity of unknown origin;
if medical treatment is ineffective.

What is the role of hysteroscopy and biopsy?

Hysteroscopy as a diagnostic procedure should be performed only if the ultrasound conclusion is ambiguous, for example, to accurately determine the location of the myomatous node or clarify the nature of the detected anomaly.

A biopsy is needed to rule out endometrial cancer or atypical hyperplasia. The indications for a biopsy are:

persistent intermenstrual bleeding;
disappearance or initial lack of effect from treatment in women 45 years of age and older.

Do not use only curettage of the uterine cavity as a diagnosis.

Which woman should be referred for endometrial testing?

It is not completely clear which of the women should be referred for endometrial research and what kind of research should be. New Zealand guidelines recommend transvaginal endometrial ultrasound for the following women:

with a body weight of more than 90 kg;
over the age of 45 (according to the English guidelines, it is recommended to conduct an additional examination after 40 years);
with other risk factors for endometrial hyperplasia or cancer, such as an established diagnosis of PCOS, infertility, parity zero pregnancies, exposure to excess estrogen, or familial cases of endometrial or colon cancer.

If the endometrial thickness is more than 12 mm on transvaginal ultrasound, a sample of the endometrium should be taken to rule out hyperplasia. If there is no transvaginal ultrasound data, then a sample of the endometrium should also be taken. Women with irregular menstrual bleeding, lack of results from drug therapy, and signs of pathology on transvaginal ultrasound (polyps or submucosal myoma nodes) are indicated for hysteroscopy and biopsy. As a diagnostic procedure, hysteroscopy and biopsy are more informative. Endometrial aspiration biopsy can serve as an alternative to biopsy. The procedure is blind, and despite greater comfort for the woman, it remains debatable whether it can replace hysteroscopy with a sufficient level of sensitivity and specificity.

An endometrial thickness greater than 12 mm may indicate hyperplasia.

Treatment of menorrhagia in women

Should all women with menorrhagia be given iron tablets?

During normal menstruation, bleeding lasts 4 ± 2 days, during which an average of 35-40 ml of blood is lost - an amount equivalent to 16 mg of iron. The recommended dietary intake of iron is sufficient to compensate for 80 ml of blood loss per month. However, the average woman does not consume enough iron in her diet, which leads to the fact that anemia can develop with a loss of 60 ml of blood per month. In most cases, the main symptom that worries women with severe uterine bleeding is weakness due to anemia. For the treatment of anemia, 60-180 mg of elemental iron per day should be consumed.

What treatment can a general practitioner prescribe for women with menorrhagia?

Drug treatment is prescribed if there are no signs of anatomical or histological pathology or there are myoma nodes less than 3 cm in diameter that do not cause expansion of the uterine cavity.

As shown in the clinical case, the general practitioner should prescribe to the woman any treatment aimed at reducing blood loss before, if necessary, she is examined by a gynecologist. There are many remedies available to the GP, including NSAIDs, hormone therapy (COCs or cyclic progestogens), tranexamic acid, and even Mirena - a LV-IUD. If drug treatment is prescribed for the duration of the study and the organization of radical treatment, tranexamic acid and NSAIDs should be used.

Medical therapy for menorrhagia is very effective and should be administered by a general practitioner.

There are several factors that influence the choice of therapy:

the presence of ovulatory or anovulatory cycles;
the need for contraception or the desire to become pregnant;
the patient's preferences (in particular, how satisfied she is with the use of hormonal therapy);
contraindications to therapy.

If, based on the history and results of examinations, medical hormonal or non-hormonal therapy is indicated, it should be prescribed in the following order:

preferably long-term (at least 12 months) use of the LV-IUD;
tranexamic acid, NSAIDs or COCs;
norethisterone or long-acting injectable progestogens.

Danazol should not be routinely used to treat heavy menstrual bleeding.

Recommendations for prescribing drug therapy for heavy menstrual bleeding

Women who are scheduled to have a LV-IUD should be warned about the possibility of changes in bleeding patterns, more often in the first few cycles, sometimes lasting more than 6 months. They should endure at least 6 cycles in order to evaluate the beneficial effect of the treatment.
When profuse uterine bleeding is associated with dysmenorrhea, NSAIDs are preferred over tranexamic acid as therapy.
The use of NSAIDs and / or tranexamic acid should be continued for as long as the woman feels the benefit from them.
The use of NSAIDs and/or tranexamic acid should be discontinued if there is no improvement within three menstrual cycles.
If initial therapy fails, a second line should be considered instead of immediate surgical referral.
Progestogens given orally only in the luteal phase of the cycle should not be used to treat heavy menstrual bleeding.

The two main first-line therapies for menorrhagia, the antifibrinolytic tranexamic acid (Cyclocapron) and NSAIDs, are non-hormonal. The effectiveness of these drugs has been proven in randomized trials and systematic reviews.

For women who are not planning pregnancy and who can have medical therapy as a first choice, insertion of a LV-IUD may be recommended.

For ease of understanding, a general practitioner may tell his patients that tranexamic acid reduces blood loss during menstruation by half, and NSAIDs by about a third. For most women with whom the GP deals, this explanation will give hope that they will be able to return to their "normal" periods and the need for surgery will disappear. Both types of drugs have the advantage of only being taken during menstruation (which promotes better adherence) and are especially suitable for women who do not require contraception and do not want to take hormone therapy. These therapies are also effective for increased menstrual bleeding associated with the use of non-hormonal intrauterine contraceptive devices.

What is the mechanism of action of tranexamic acid, its side effects and contraindications?

Tranexamic acid inhibits the activation of plasminogen and suppresses the fibrinolytic activity of the blood. Reviews have shown that the correct use of tranexamic acid (taken with the onset of bleeding) for 2-3 cycles reduced the loss of menstrual blood by 34-59%. Adverse events such as nausea, vomiting, diarrhea and dyspepsia were observed in 12% of women. Unlike NSAIDs, tranexamic acid had no effect on dysmenorrhea. Contraindications include a history of venous thromboembolism or stroke, an acquired color vision disorder.

It is also important to note that tranexamic acid:

does not affect dysmenorrhea/pain associated with bleeding, so additional pain relief may be required;
does not have a contraceptive effect, so additional contraception may be required;
does not regulate the menstrual cycle, therefore, if necessary, additional counseling and treatment may be required.

How should NSAIDs be prescribed to treat menorrhagia?

Any NSAID can be used, but the most commonly prescribed are:

mefenamic acid (Ponstan);
diclofenac (Voltaren);
naproxen (Naprosin).

A woman should only take pills during her period. With dysmenorrhea, for maximum effectiveness, you should try to start taking it when menstruation should begin. The general practitioner should be alert to contraindications to NSAIDs. These include:

ongoing gastrointestinal bleeding or ulcers;
inflammatory bowel disease;
a history of hypersensitivity (asthma, angioedema) caused by taking aspirin or NSAIDs;
dysfunction of the kidneys or liver.

How useful is hormone therapy?

Traditionally, hormonal therapy for menorrhagia has consisted of the use of progestogens given during the luteal phase of the cycle. Gestagens effectively reduce blood loss only if they are administered within 21 days of each cycle. However, complications of such therapy can lead to the fact that patients refuse to continue it.

COC therapy is perhaps more familiar to the general practitioner. In the absence of contraindications, the appointment of COCs has a beneficial effect in menorrhagia. In addition to providing contraception, drugs significantly reduce the amount of blood lost during menstruation. A general practitioner can choose the most suitable pills for a woman. For example, if levonorgestrel does not reduce bleeding enough, a drug containing norethisterone or progestogen-containing third-generation contraceptives can be tried. The doctor may also suggest that the woman skip the pacifiers in the package and drink hormone pills continuously - this will give a good rest from menstruation. COCs are also effective for anovulatory bleeding because they regulate the cycle.

Due to its economic feasibility for long-term use, the LV-IUD (Mirena) is the preferred and final method of therapy. It is a T-shaped base coated with a reservoir of levonorgestrel released at a rate of 20 mg per day. Due to this low level of hormones, systemic side effects of progestogens are minimized. Therefore, patients are more likely to continue this therapy than cyclic progestogens. The IUD exerts its effect by reducing the proliferation of the endometrium and, as a result, reducing the duration and severity of bleeding. Up to six months, and especially in the first three months after the installation of the system, the patient may be disturbed by irregular bleeding and scanty spotting, but by 12 months. most have only minor bleeding or amenorrhea. Many of the problems associated with bleeding and scanty spotting can be overcome with careful prior counseling.

What are the principles of surgical treatment?

Medical treatment of menorrhagia by no means excludes the possibility of surgery as the next step. At the same time, a conservative approach can give a woman time to recover from "heavy menstruation" and consider all possible options for further treatment, including surgery. If drug treatment was not used, then the woman may decide that the operation is the only way out of the difficult situation in which she finds herself. For many women, hysterectomy is actually the best choice, meaning that they no longer need treatment for menorrhagia.

Important

A third of women complain of heavy menstruation, but only 10% have menorrhagia.
Until recently, 20% of women of late reproductive age had to have their uterus removed.
The main cause of heavy bleeding are anovulatory cycles and uterine fibroids.
Risk factors for hyperplasia and endometrial cancer in premenopausal women include infertility and no pregnancy, exposure to excess endogenous or exogenous estrogens or tamoxifen, PCOS, obesity, and a family history of endometrial or colon cancer.
All women with metrorrhagia should have a complete blood count.
Medical therapy for menorrhagia is very effective.
Tranexamic acid reduces blood loss during menstruation by half, and NSAIDs by about a third.
Progestogens are only effective for menorrhagia if they are given for at least 21 days.
In the treatment of menorrhagia, COCs, LV-IUD Mirena are also effective.
If medical hormonal or non-hormonal therapy is indicated based on history and examination results, LV-IUS insertion is the preferred method for long-term use.

Few people know how menorrhagia manifests itself, what it is. In medicine, there are a number of diagnoses that characterize fairly familiar diseases, but at the same time their names seem unknown and discourage a person, he does not know what is happening to him and how to treat him.

One of these diseases can be called the diagnosis of menorrhagia in women. The fair sex is quite impressionable individuals, they worry often and for no apparent reason, and upon hearing such a strange diagnosis, they may even panic.

Symptoms of pathology

Menorrhagia - menstruation, which is characterized by profuse blood loss, exceeding all permissible norms. During menstruation, a woman can normally lose up to 150 ml of blood. If these indicators are violated, then it is likely that pathological processes occur in the body.

Menorrhagia can be primary, that is, develop along with the first menstruation, or it can appear already in adulthood, when the menstrual cycle has returned to normal. Menorrhagia is a condition that indicates the development of one of the gynecological diseases, for example, uterine fibroids or ovarian dysfunction. It is a typical symptom of hypermenstrual syndrome.

Hypermenstrual syndrome is a condition in which menstruation lasts longer than 7 days. The problem of large blood loss during menstruation worries about 30% of women, but not everyone seeks help, although menorrhagia requires treatment without fail.

The main symptom of menorrhagia, or, as it is also called, hypermenorrhea, is a large blood loss. In this condition, doctors do not observe violations of the regularity of the menstrual cycle. In the secretions, blood clots of various sizes can occur.

Prolonged hypermenorrhea leads to the development of anemia. This condition is often accompanied by dizziness, nausea, abdominal pain, causeless weakness and decreased performance. Many women suffering from this disease note the appearance of bruises, bruises on the body, the occurrence of frequent bleeding from the nose and gums. Sometimes the discharge is so abundant that women have to change pads every half hour.

Reasons for the development of the disease

There can be several reasons for this condition of a woman. In 80% of all cases, menorrhagia is caused by gynecological diseases such as endometriosis or uterine fibroids. Strongly affects the menstrual cycle and hormonal imbalance or failure, which could be caused by drugs. Violations of the normal functioning of the genital organs may be associated with thyroid diseases or blood clotting problems, that is, thrombocytopenia. Hypermenorrhea requires mandatory consultation not only with a gynecologist, but also with other doctors. It is likely that the causes of the pathological condition during menstruation may lie in diseases of the liver, heart, and metabolic disorders in the body.

In the modern world, the cause of heavy periods can be intrauterine contraceptives that have been installed incorrectly. Athletes should understand that heavy physical activity is contraindicated for women - this is also a likely cause of hypermenorrhea.

A similar reaction of the female body can cause hard and frequent diets. Climate change and constant stress also affect the menstrual cycle. Doctors have an opinion that menorrhagia is hereditary. If your mother or grandmother had problems with bleeding during periods, it is likely that they were passed on to you genetically.

This problem is very common among teenagers. The thing is that this is normal for them, since in a growing body the hormonal background is unstable. The balance between estrogen and progesterone is disturbed, which causes hypermenorrhea. Girls 13-15 years old are very difficult to tolerate this condition, so you should definitely consult a doctor. If you do not go for a consultation at an early age, by the age of 20, a girl may develop polycystic ovaries.

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Treatment of hypermenorrhea

To avoid future problems with reproductive function, treatment should be started as soon as possible.

Self-medication in this matter is strictly prohibited, since not only your current state of the body depends on it, but also the ability to endure and give birth to a healthy child.

Drug treatment of hypermenorrhea involves the use of hormonal contraceptives, which help to normalize the imbalance of progesterone and estrogen. This method of treatment, as a rule, can reduce blood loss by about 40%. The drug and dosage of use are prescribed by the doctor on an individual basis. In no case should you use medications that were prescribed by your friends with a similar diagnosis. Those drugs that helped them can significantly harm you.

Women with advanced menorrhagia may be given iron supplements. This prevents the development of anemia. The use of ascorbic acid or rutin helps to reduce the abundance of blood loss. Sometimes hypermenorrhea requires complex treatment, so anti-inflammatory drugs are included in the therapy. When blood loss is very strong, drugs such as Calcium Gluconate, Calcium Chloride, Dicinone and Aminocaproic Acid will help stop them.

As an addition to traditional treatment, physiotherapy and homeopathic remedies can be used. The method of traditional medicine here will not give a result, it can only eliminate the symptoms for a while, but it is not able to cure the disease.

Treatment of menorrhagia can also be surgical. Surgical intervention for this pathology is indicated in the following cases:

there is physical damage to the genital organs or a violation in their normal operation;
recurrence of hypermenorrhea;
the ineffectiveness of the use of therapeutic methods of treatment;
Iron-deficiency anemia.

During the intervention, the uterine cavity is scraped, which makes it possible to prevent large blood loss for several periods, although then the probability of relapse will be 78%. If the blood loss is very strong, polyps or uterine fibroids are diagnosed, then the organ is removed entirely. In most cases, such drastic measures are taken only after the woman is 40 years old. At a younger age, this operation is performed in critical cases.

Menorrhagia is a condition that gives a woman a lot of problems and inconvenience, not only physiological, but also psychological. It significantly reduces the quality of life and literally erases several days a month from a woman's life. A woman cannot normally leave the house and do her usual things. If you are faced with a similar problem, in no case do not expect it to go away by itself. This pathological condition requires immediate treatment.

The method of treatment is chosen by the doctor depending on the age of the patient, the duration of menstruation and the abundance of blood loss during this period.

Diagnostics and prevention

Diagnosis of this disease allows a procedure such as hysteroscopy. It makes it possible to identify any pathologies in the uterus and eliminate them in time. During the examination, the doctor must exclude an ectopic pregnancy, which is characterized by causeless blood loss. To confirm the diagnosis, the doctor prescribes an ultrasound, biopsy, colposcopy, smear for oncocytology, analysis of the endometrium of the uterus and curettage. Based on the results obtained, a treatment regimen is developed.

As a preventive measure for this disease, it can be advised to undergo a gynecological examination 2 times a year and promptly treat inflammatory diseases and infections that are sexually transmitted. Eliminate heavy loads, do not succumb to stress and emotional shocks. Follow the rules of personal hygiene, lead a healthy lifestyle and give up bad habits. Remember that in an organism with a high level of protection (increased immunity), diseases and pathologies develop much less frequently. This also applies to such a condition as hypermenorrhea.

(Profuse menstruation) - blood loss during menstruation, exceeding the physiological norm (~ 150 ml). It can serve as a manifestation of inflammatory processes in the female genital area, uterine fibroids, ovarian dysfunction, neuropsychic overwork. It entails the development of anemia, a violation of the ability to work and the quality of life of a woman. Other complications depend on the cause of the underlying disease. Menorrhagia is diagnosed according to the history, gynecological examination, ultrasound of the pelvic organs. If necessary, a biopsy and cytological examination is performed. Treatment of menorrhagia can be therapeutic and surgical.

General information

is one of the variants of hypermenstrual syndrome (heavy periods), in which regular menstrual bleeding lasts more than 7 days, and blood loss in this case is more than 100-150 ml. Abundant and prolonged menstruation disturbs about 30% of women, however, not all of them turn to the gynecologist with the problem of menorrhagia. Distinguish between primary menorrhagia, which occurs simultaneously with the first menstruation, and secondary - developing after a period of normal menstruation.

Symptoms of menorrhagia

The main manifestation of menorrhagia is prolonged and profuse menstrual flow with blood clots. Prolonged and severe blood loss can lead to anemia, which manifests itself in a deterioration in well-being, weakness, dizziness, and the development of fainting. Often with menorrhagia, bleeding from the gums and nose, bruising, bruising on the body occur. With menorrhagia, menstruation is so heavy that a woman is forced to replace a sanitary tampon or pad every hour, and sometimes more often.

The main causes of menorrhagia

The following disorders can serve as the reasons leading to the development of menorrhagia:

Hormonal instability. It is especially pronounced in patients of premenopausal and transitional age. Hormonal instability during these physiological periods increases the risk of menorrhagia.
Diseases of the reproductive system: fibroids , polyps , uterine adenomyosis , ovarian dysfunction . They develop due to hormonal imbalance in the body and cause menorrhagia in 80% of women.
Use of intrauterine contraceptives. Menorrhagia in this case is an undesirable side effect that may require removal of the IUD (intrauterine device).
Diseases associated with a violation of the blood coagulation system(for example, vitamin K deficiency, thrombocytopenia), as well as taking certain drugs that affect clotting (anticoagulants). Increased bleeding that accompanies disorders of the blood coagulation system can be manifested by heavy menstruation - menorrhagia.
hereditary menorrhagia. Often, menorrhagia is a family disease transmitted through the female line of inheritance.
Diseases of the pelvic organs, thyroid gland, kidneys, liver, heart. With menorrhagia, the patient should consult with an endocrinologist and a therapist to exclude endocrine and general somatic causes of heavy menstruation.
Excessive power loads, overwork, stressful situations, changing climatic conditions All factors that force the body to adapt to new conditions and stress can trigger the development of menorrhagia.

Diagnosis of menorrhagia

The diagnosis of "menorrhagia" is made on the basis of complaints and signs of excessive blood loss. With any uterine bleeding, pregnancy is excluded, especially ectopic. To exclude pregnancy and the pathology associated with it allows a pregnancy test - the determination of human chorionic gonadotropin in the blood.

For the diagnosis of menorrhagia, history data (medication, complications of previous pregnancies and childbirth, etc.) are important. To determine the causes of menorrhagia, the vagina and cervix are examined for the presence of foreign bodies, traumatic injuries, polyps, tumors, inflammatory or atrophic changes.

If a pathology of the uterus and ovaries is suspected, diagnostic procedures are carried out: ultrasound of the pelvic organs, hysteroscopy, cervical biopsy, curettage and analysis of endometrial tissue. Methods of laboratory diagnostics for menorrhagia examine hemoglobin, conduct a biochemical blood test and a coagulogram, determine the hormonal background, tumor markers CA 19-9, CA-125. To detect precancerous or cancerous cells in the cervix, a cytological analysis of a Pap smear is performed.

Therapeutic treatment of menorrhagia

The method of treatment for menorrhagia is selected depending on the cause, abundance and duration of menstrual bleeding. Self-medication of menorrhagia can only aggravate the disease.

Long-term hormonal contraception is prescribed as a drug therapy for menorrhagia to regulate hormonal balance. Progesterone and estrogen, which are part of oral contraceptives, prevent excessive growth of the endometrium and reduce the amount of discharge during menstruation by more than 40%. The selection of oral contraceptives is carried out at the consultation of a gynecologist on an individual basis.

Women with menorrhagia are advised to take iron supplements to avoid iron deficiency anemia. Taking rutin and ascorbic acid will help reduce blood loss. Anti-inflammatory drugs (ibuprofen) are used to treat menorrhagia, which affect the duration and amount of bleeding. With severe bleeding, hemostatic drugs are prescribed - etamsylate, chloride or calcium gluconate, aminocaproic acid. If the hormonal balance is disturbed, homeopathic treatment is effective.

Levonogestrel intrauterine systems are used to treat menorrhagia. Having a contraceptive effect, they prevent the proliferation of the endometrium, reduce its thickness and blood supply. However, if menorrhagia is caused by the use of an intrauterine device, then it should be removed and other methods and means of protection should be used. Women with menorrhagia are recommended to normalize the regime, good rest and nutrition. After the cessation of menstrual bleeding, a course of physiotherapeutic procedures is carried out (10-15 sessions of ozocerite and diathermy). Some cases of menorrhagia require surgery.

Surgical treatment of menorrhagia

Her mother should come to the initial consultation together with the girl and inform the doctor about the family history, the course of pregnancy and the diseases the child has had. The doctor evaluates the patient's anthropometric data (height, weight), the degree of development of secondary sexual characteristics to exclude pathological processes that affect the development of the girl. The time of the onset of menstruation, the features of the course and characteristics of the menstrual cycle (cycle duration, duration, profusion and soreness of menstrual bleeding, etc.) are clarified. Attention is paid to the influence of menstruation on the general well-being and performance of the girl (does she miss classes due to menorrhagia, does she go to sports sections, etc.). This information is an important indicator of both general and gynecological health of an adolescent.

Mandatory for menorrhagia in adolescents is the study of blood hemoglobin to detect anemia. In the presence of iron deficiency anemia in patients with menorrhagia, iron preparations are prescribed. To regulate the menstrual cycle in teenage menorrhagia, low-dose hormonal contraceptives are used, containing no more than 35 micrograms of the estrogen component in 1 tablet of the drug. It will be useful to teach the girl to maintain a menstrual calendar with fixation of the characteristics of the menstrual cycle.

The effectiveness of the treatment of menorrhagia is evaluated after about 6 months, and its indicator is the restoration of the normal amount of menstrual bleeding. In the future, observation by a gynecologist is standard - 2 times a year.

Prevention of menorrhagia

Menorrhagia, even if it is not a manifestation of a serious and dangerous disease, gives a woman a lot of inconvenience and significantly worsens her quality of life. As a preventive measure for the development of menorrhagia, women are advised to refrain from excessive physical exertion, doing power sports, avoid overwork, stress, and sudden changes in climatic conditions. With the ineffectiveness of these measures and the deterioration of health, a visit to a doctor should be immediate.

For the prevention of menorrhagia, it is useful to take multivitamin complexes, including B vitamins, vitamin C, folic acid and iron. Regular filling of the menstrual calendar will help determine the moment of menorrhagia, which will allow timely diagnostic and therapeutic measures.

Bleeding is always a medical emergency. Therefore, delaying a visit to the doctor with the development of menorrhagia, the woman independently exacerbates the severity of anemia, increases the risk of developing endometritis, and worsens the state of the blood coagulation system.

Menorrhagia is defined by doctors as heavy and heavy periods or excessive uterine bleeding that lasts for seven days. This condition can disrupt the woman's usual course of life and is a serious emotional stress for her.

The classical definition of menorrhagia is the loss of more than 80 ml of blood per cycle, but this figure is very difficult to measure. Instead, doctors use the frequency of tampon or pad changes to diagnose.

Causes and risk factors

The exact cause of menorrhagia is unknown, but an imbalance in the amount of female hormones - progesterone and estrogen - plays an important role. The most common causes and risk factors for developing this condition are:

It happens that hypermenorrhea develops due to a combination of several factors.

Women with this disease suffer from bleeding that lasts more than 7 days, compared to a normal 4-5 days, and lose more than 80 ml of blood per day. The need to change hygiene protection almost every hour can be a key diagnostic sign of menorrhagia.

If you have the following symptoms, you should immediately consult a doctor:

The main reason for visiting a doctor is discomfort in women who suffer from excessively heavy periods. In addition, heavy bleeding is often accompanied by pain.

Classification and diagnosis

Before diagnosing a particular disease, you should decide on the exact terminology. Depending on the clinical picture, the following types of similar conditions are distinguished:

NMC by type of menorrhagia is the same as hypermenorrhea - prolonged and profuse uterine bleeding with a preserved menstrual rhythm. They are diagnosed with a duration of more than 7 days and blood loss above 80 ml. Ovulation occurs in such cases.
Polymenorrhea - bleeding that occurs against the background of a stably shortened menstrual cycle. Menstruation in this case lasts less than 21 days and is usually accompanied by infertility.
Metrorrhagia, or menometrorrhagia - uterine bleeding that is not characterized by the presence of a rhythm. They often occur after a long absence of menstruation or oligomenorrhea.

In modern medicine, for the diagnosis of menorrhagia and metrorrhagia, along with the collection of anamnesis, additional tests are required. Tests to determine menorrhagia:

Blood tests are done to detect (a symptom of anemia) and determine the causes of menorrhagia. For example, diseases of the thyroid gland, ovaries or disorders of the coagulation system can be diagnosed.
Papp test. For the study, a cervical smear is taken, which is checked for signs of infection, inflammation, and cancer.
Biopsy of the endometrium. A tissue sample is collected and checked for signs of inflammation, cancer, and other abnormalities. This procedure may cause some discomfort and pain similar to menstruation.
ultrasound. Ultrasound is used to take images of the uterus, appendages, and ovaries, which can help doctors detect changes in these organs.
Hysteroscopy. This test allows you to directly visualize the uterus through a tiny camera that is inserted through the vagina and cervix.

The complex of diagnostic measures is selected by the doctor after collecting an anamnesis individually for each patient.

Treatment and prevention

A number of methods can be used to relieve the symptoms and treat menorrhagia or metromenorrhagia. The choice depends on the age of the patient, medical history, the desired result and the intention to become pregnant in the future. Surgical techniques are typically used in patients who do not respond to medical therapy.

Menorrhagia is one of the disorders of the menstrual cycle, which is expressed in severe blood loss during menstruation (more than 150 ml), the duration of which also exceeds the physiological norm (over seven days). This phenomenon can signal inflammation of the internal genital organs and the woman's system. This phenomenon can also be provoked by uterine fibroids, ovarian dysfunction, as well as neuropsychic overwork. One of the serious complications of menorrhagia is iron deficiency anemia, in addition, heavy blood loss negatively affects the working capacity and quality of life of a woman.

Prolonged and heavy bleeding during menstruation disturbs more than thirty percent of women in the world, but with all this, not everyone is in a hurry to seek help with this problem from a specialist. In medical practice, primary menorrhagia is distinguished, which appears with the first menstruation, and secondary, which develops later after the formation of a regular menstrual cycle.

Causes of occurrence.
Hormonal imbalance or hormonal fluctuations can lead to menorrhagia. It should be noted that women at the beginning of menopause and girls of transitional age are at risk of developing this disorder, because it is during these periods that hormonal changes in the body are observed, during which disruptions in the endocrine system are likely.

Another common cause that can cause the development of menorrhagia is the presence of diseases of the reproductive system, in particular ovarian dysfunction, uterine fibroids or fibroids, polyps, adenomyosis of the uterus (when the glands of the uterine lining begin to build into its muscles, which provokes pain and bleeding), the presence benign tumors of the uterus.

The use of intrauterine contraception (IUD) can cause an undesirable side effect in the form of heavy bleeding during menstruation, which will require abandoning the use of this method of contraception.

In rare cases, this phenomenon may be a symptom of cancer of the female genital organs (cancer of the uterus, cervix, ovaries).

An ectopic pregnancy can cause heavy blood loss during menstruation.

Blood diseases associated with a violation of its coagulability can provoke menorrhagia (lack of vitamin K, thrombocytopenia), as well as taking medications (anticoagulants) that affect coagulation.

In rare cases, heavy periods can be hereditary and can be passed down the female line.

Some diseases of the pelvic organs, kidneys, thyroid gland, heart, liver, as well as endometriosis can provoke the development of menorrhagia.

In addition to various diseases and inflammatory processes, frequent stressful situations in which a woman finds herself, overwork, excessive physical exertion, and a change in climatic conditions can also cause menorrhagia.

In any case, with the appearance of strong and prolonged menstrual bleeding, it is necessary to urgently consult with an endocrinologist and a therapist in order to exclude endocrine and general somatic causes that contribute to the development of this phenomenon.

Symptoms.
The main signs of menorrhagia are heavy and prolonged menstrual bleeding accompanied by blood clots. The abundance of menstruation is expressed in the fact that a woman has to replace sanitary tampons or pads every hour or more. Prolonged blood loss can lead to the development of anemia, which is expressed in a sharp deterioration in the general condition, the appearance of weakness, dizziness, fainting. There are cases when, with this phenomenon, nosebleeds occur, bruises appear on the body and bruises.

Diagnostics.
Menorrhagia is diagnosed based on the patient's symptoms and complaints of severe blood loss during menstruation. When making a diagnosis, the probability of pregnancy, including ectopic pregnancy, is excluded, for which a pregnancy test is performed and a blood test is taken for the presence of chorionic gonadotropin in it. Also, in the diagnosis of this disorder, the data of the anamnesis are important, in particular, the complication of previous pregnancies, childbirth, taking medications, etc.

When the causes of menorrhagia are identified, the vagina and cervix are examined for the presence of tumors, polyps, foreign bodies, damage, inflammation or atrophic changes.

If a specialist suspects a pathology of the uterus and ovaries, then diagnostic procedures are prescribed, in particular a biopsy of the cervix, ultrasound of the pelvic organs, hysteroscopy, curettage and analysis of endometrial tissue.

With the help of laboratory diagnostic methods in the case of menorrhagia, hemoglobin is examined, a biochemical blood test is performed and a coagulogram is performed, the hormonal background, tumor markers CA 19-9, CA-125 are determined.

A cytological analysis of a Pap smear makes it possible to detect precancerous or cancerous cells in the cervix.

For patients suffering from menorrhagia, experts recommend keeping a special menstrual calendar, where to record the duration of each menstruation, the abundance and nature of the discharge. The amount of blood loss is determined by how often you change your pad or tampon.

Menorrhagia in adolescents.
Very often, this phenomenon is observed in girls aged thirteen to sixteen years old, because during this period their hormonal background is not stable. The main reason for the development of heavy periods in adolescents is an imbalance of the hormones progesterone and estrogen, which affect the processes of maturation and rejection of the endometrium of the uterus. Complications of menstruation can be observed against the background of an increase in the thyroid gland, a violation of blood clotting, the penetration of infections into the genital tract. Often, menorrhagia in adolescents is provoked by a violation of hemostasis (the body's reactions aimed at preventing and stopping bleeding), which is hereditary in nature.

In adolescence, menorrhagia is especially difficult to tolerate, therefore, it requires immediate medical attention to identify the causes and correct violations. If during this period the teenager does not receive proper treatment, then in the future, in thirty percent of cases, polycystic ovaries develop.

The mother should bring the teenager to the first appointment, who will tell the specialist about the family history, the course of pregnancy and the diseases the child has had. On examination, the doctor pays attention to the height and weight of the teenager, the degree of development of secondary sexual characteristics in order to exclude the likelihood of the development of pathological processes that affected the development of the girl. The doctor also specifies when the teenager's first menstruation began, the features of its course and the main characteristics of its cycle (its duration, duration, profusion and pain of menstrual bleeding). The doctor also finds out whether menstruation affects the general well-being and performance of the girl. All collected information characterizes the general and gynecological state of health of the patient.

It should be noted that when menorrhagia is detected in adolescent girls, a blood test for the presence of anemia is mandatory. In case of a positive result, iron preparations are prescribed.

The effectiveness of the treatment of this disorder can be assessed after about six months. It is during this period that the normal amount of menstrual bleeding is restored. After effective treatment, the girl should be observed by a gynecologist twice a year.

Treatment of menorrhagia.
Therapy of this disease is carried out depending on the cause that caused it, as well as taking into account the duration and abundance of menstrual bleeding. Self-medication, especially in adolescence, is not recommended, as this can greatly aggravate the disease.

Drug treatment of this disease usually includes the appointment of oral contraceptives that regulate hormonal balance. In addition, the progesterone and estrogen contained in them prevent excessive growth of the endometrium and reduce the amount of menstrual flow by more than forty percent. The selection of contraceptive pills is carried out in each case individually by a gynecologist.

Women with prolonged menorrhagia are given iron supplements to prevent the development of iron deficiency anemia. To reduce blood loss during menstruation, it is recommended to take rutin and ascorbic acid.

In the case of tumors and diseases of the thyroid gland, either drug or surgical therapy is indicated. An underactive thyroid can cause weight gain, dry skin, and lethargy and heavy menstrual bleeding.

In the treatment of menorrhagia, anti-inflammatory drugs (ibuprofen) are also used, which affect the duration and amount of discharge during menstruation.

With extremely severe blood loss, hemostatic drugs are prescribed, for example, Dicinon, Chloride or Calcium Gluconate, Aminocaproic acid.

To normalize the hormonal background, homeopathic treatment is also prescribed.

One of the ways to treat menorrhagia is also the appointment of intrauterine systems with levonogestrel. In addition to the contraceptive effect, they prevent the proliferation of the endometrium, reducing its thickness and blood supply. If the intrauterine systems were the cause of menorrhagia, then they are removed.

In some cases, menorrhagia requires urgent surgical treatment (hysterectomy or removal of the uterus).

Surgery.
With a recurrent course of the disease, physiological disorders or damage to the genital organs, severe iron deficiency anemia, as well as the ineffectiveness of the treatment using medications, surgical treatment is indicated.

In order to diagnose and treat menorrhagia, hysteroscopy is performed. This procedure makes it possible to identify any pathology of the uterus (endometrial polyps) and eliminate it. Curettage of the uterine cavity during a period of several menstrual cycles reduces bleeding, but then the disease resumes again.

Long and heavy periods in the presence of fibroids or polyps are treated with surgical removal of the uterus.

Operative treatment of menorrhagia is indicated for women after forty years, before this period, such treatment is used in especially severe cases.

Prevention.
This disease, even if it is not caused by a serious pathology or inflammation, causes a lot of inconvenience to women, worsening the quality of life. Therefore, it is important to follow some preventive measures that will help prevent the development of this phenomenon. These include abstinence from excessive physical exertion and the rejection of power sports. In addition, it is recommended to avoid stressful situations, severe overwork, a sharp change in climatic conditions. If such measures did not give a result, and the state of health is still deteriorating, you should consult a doctor.

Maintaining a menstrual calendar will make it possible to determine the moment of menorrhagia and to carry out diagnostic and therapeutic measures in time.