GET TO KNOW MORE ON MENORRHAGIA (HEAVY MENSTRUAL BLEEDING)!!

Do you know that menorrhagia is one of the most common reasons for referral to a gynaecologist? Up to 25% of women suffer at least one episode of dysfunctional uterine bleeding during their reproductive age.

GET TO KNOW MORE ON MENORRHAGIA (HEAVY MENSTRUAL BLEEDING)!!

Written by Bukola| Published on 29/09/22

WHAT IS MENORRHAGIA?

 

  • Menorrhagia is excessive (heavy) menstrual blood loss that occurs regularly (every 24 to 35 days) which interferes with a woman's physical, emotional, social, and material quality of life.
    • The average blood loss during menses is 30–40 mL, and 90% of women have losses less than 80mL.
    • Excessive menstrual blood loss is classified as 80 mL or more and/or a duration of more than 7 days — direct measurement of menstrual blood loss is accurate, but complex to undertake in clinical practice.  
    • Excessive menstrual bleeding is also defined as the need to change menstrual products every one to two hours, passage of clots greater than 2.54 cm, and/or 'very heavy' periods as reported by the woman.
  • Menorrhagia can occur alone or in combination with other symptoms.

(Sweet, 2012Duckitt 2015NICE, 2018).

 

IT’S PREVALENCE?

 

The prevalence of menorrhagia increases with age, peaking in women aged 30–49 years.

Five percent of women aged 30–49 years in the UK, and 2–4% of pre-menopausal women in New Zealand consult their GP each year due to excessive uterine bleeding.

In the UK 20% of women have a hysterectomy before the age of 60, mainly to alleviate heavy bleeding.

[IOG, 2015; BMJ, 2017a; BMJ, 2017b]

 

 

WHAT ARE THE UNDERLYING CAUSES OF MENORRHAGIA?

 

  • In almost 50% of women with menorrhagia, no cause is identified — this is classified as dysfunctional uterine bleeding. 
  • In other women, the aetiology can be classified by the cause

CAUSES OF MENORRHAGIA INCLUDE:

1). Uterine and ovarian pathologies: This includes:

      • Uterine fibroids causes dysmenorrhoea (severe and frequent menstrual cramps and pain during your period), pelvic pain) — reported in 10% of women with menorrhagia and in 40% of women with severe menorrhagia (blood loss of 200 mL/cycle or more). 
      • Endometriosis and adenomyosis causes (dysmenorrhoea, dyspareunia (persistent or recurrent genital pain that occurs just before, during or after sex), pelvic pain, difficulty conceiving).
      • Pelvic inflammatory disease and pelvic infection (for example chlamydia — may also present with vaginal discharge, pelvic pain, intermenstrual and postcoital bleeding, and fever).
      • Endometrial polyps (intermenstrual bleeding).
      • Endometrial hyperplasia or carcinoma causes (postcoital bleeding, intermenstrual bleeding, and pelvic pain).
      • Polycystic ovary syndrome (causes anovulatory menorrhagia and irregular bleeding).

2). Systemic diseases and disorders:

      • Coagulation disorders (for example von Willebrand disease).
      • Hypothyroidism- Low thyroid levels (which may also present with fatigue, constipation, intolerance of cold, and hair and skin changes).
      • Diabetes mellitus. 
      • Hyperprolactinaemia. 
      • Liver or renal disease.

 

3). Iatrogenic causes:

      • Anticoagulant treatment.
      • Chemotherapy.
      • Herbal supplements (for example ginseng, ginkgo, and soya) — these may cause menstrual irregularities by altering oestrogen levels or coagulation parameters.
      • Intrauterine contraceptive device. 

[Sweet, 2012ACOG, 2013Duckitt 2015BMJ, 2017b]

 

 

WHAT ARE ITS COMPLICATIONS?

 

Quality of life — heavy menstrual bleeding may negatively affect the woman's physical, social, emotional and/or material quality of life.

Iron deficiency anaemia — this occurs in about two-thirds of women with heavy menstrual bleeding.

Endometrial pathology — there is an increased risk of endometrial pathology and possible development of endometrial cancer when anovulatory dysfunctional uterine bleeding lasts for years without treatment.

[Duckitt 2015; BMJ, 2017b; NICE, 2018].

 

 

 

PLEASE REFER TO YOUR PRIMARY CARE PROVIDER FOR FURTHER ADVICE, DIAGNOSIS AND TREATMENT).

 

 

 

REFERENCE

 

  • ACOG (2013) Committee opinion: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. The American College of Obstetricians and Gynecologists. https://www.acog.org [Free Full-text]
  • BMJ (2017a) Menorrhagia. BMJ Best Practice. http://www.bestpractice.bjm.com
  • BMJ (2017b) Dysfunctional uterine bleeding. BMJ Best Practice. http://www.bestpractice.bjm.com
  • BMJ (2017c) Uterine fibroids. BMJ Best Practice. http://www.bestpractice.bmj.com
  •  
  • Duckitt, K. (2015) Menorrhagia. Clinical Evidence. BMJ Publishing Group Ltd. http://www.clinicalevidence.com
  • Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland (2015) The investigation and management of menorrhagia. Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland. https://www.rcpi.ie/faculties/obstetricians-and-gynaecologists/national-clinical-guidelines-in-obstetrics-and-gynaecology [Free Full-text]
  • National Institute for Health and Clinical Excellence (2013) Quality standard: Heavy menstrual bleeding. NICE.
  • NICE (2016) Heavy menstrual bleeding: assessment and management. National Institute for Health and Clinical Excellence. 
  • NICE (2017) Key therapeutic topics. National Institute for Health and Care Excellence.
  • NICE (2018) Heavy menstrual bleeding: assessment and management. National Institute for Health and Care Excellence. 
  • RCOG (2013) Clinical recommendations on the use of uterine artery embolisation in the management of fibroids. Royal College of Obstetricians and Gynaecologists. http://www.rcog.org.uk [Free Full-text]
  • Sweet, M.G., Schmidt-Dalton, T.A., Weiss, P.M. and Madsen, K.P. (2012) Evaluation and management of abnormal uterine bleeding in premenopausal women. American Family Physician 85(1), 35-43. [Abstract]