Menstrual bleeding that is heavier than normal
- More common over the age of 40
- Being overweight is a risk factor
- Genetics is not a significant factor
Some women have heavier periods than others. Menorrhagia is heavy bleeding that requires sanitary pads or tampons to be changed frequently and may include blood clots. Sometimes the bleeding may be so heavy that it cannot be controlled by pads or tampons and “flooding” occurs. Menorrhagia may be associated with a dragging pain in the lower abdomen. Menstruation may also be irregular (see Irregular periods). Severe menstrual bleeding may lead to iron-deficiency anaemia. About 1 in 20 women has menorrhagia regularly. It is more common in women approaching the menopause.
What are the causes?
Heavy or prolonged menstrual bleeding can be a symptom of disorders of the uterus, such as fibroids, uterine polyps, endometriosis, persistent pelvic infections, or, more rarely, cancer of the uterus. Menorrhagia is also a side effect of using an intrauterine contraceptive device (IUD). A single heavy period that is late may be a miscarriage. Menorrhagia may also be caused by a hormonal disorder, such as hypothyroidism. The condition is more common in overweight women.
Sometimes, the cause is not clear. If your periods have always been heavy, there is probably no need for concern. You should consult your doctor if the problem affects your lifestyle and to check there is no underlying disorder.
How is it diagnosed?
Your doctor will examine you and may arrange for blood tests to measure your hormone levels and to look for signs of anaemia. Further investigations, such as ultrasound scanning to look for fibroids or polyps in the uterus, may be necessary. You may also have a hysteroscopy. A small sample of the endometrium (the lining of the uterus) may be taken for analysis (see Endometrial sampling).
What is the treatment?
Treatment depends on the cause, your age, and the severity of the bleeding. Any under-lying disorder will be treated. If no obvious cause is found, drugs may initially be given to reduce blood loss. You may want to consider changing your method of contraception if you use an IUD. If you are overweight, losing weight may help. In some cases, your doctor may recommend an IUS (intrauterine progesterone-only system), which reduces bleeding and provides contraception.
If initial treatments do not help or if menorrhagia is severe, you may require endometrial ablation, in which a laser or diathermy (heat treatment) is used to destroy the tissue lining the uterus, or an operation to remove the uterus (see Hysterectomy). These procedures are irreversible and are usually only offered to women who do not want to have children in the future. Endometrial ablation is a minor procedure, but it carries a small risk that problems will recur if any endometrial tissue remains. A hysterectomy is a major operation but ensures that menorrhagia will not recur.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.
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