Causes of menorrhagia.
The causes of menorrhagia are due to various factors. Understanding what the causes of menorrhagia are means that your doctor will be able to find the right treatment for you.
Some of the factors are:
Hormonal imbalance: an imbalance in the hormones that regulate the menstrual cycle such as oestrogen and progesterone, can result in excessive bleeding. Conditions such as Polycystic Ovary Syndrome or thyroid disorders can disrupt hormone levels.
Conditions that affect the uterus, for example fibroids – noncancerous growths in the uterine wall, polyps (small benign growths in the uterine lining), and adenomyosis – a condition where endometrial tissue grows into the uterine muscle can lead to heavy bleeding
Von Willebrand disease: a condition that make you bleed easily
Pelvic Inflammatory Disease (PID): infections in the reproductive organs can result in heavy menstrual bleeding as a symptom.
Some medications such as blood thinners can increase the risk of heavy menstrual bleeding.
How is menorrhagia diagnosed?
It is important to talk to your health care provider if you suspect you have menorrhagia. This involves:
Medical history: the doctor will ask about your menstrual history and any other underlying medical conditions or medications you are taking.
Physical examination: the doctor will conduct a pelvic exam to identify any abnormalities in the uterus or surrounding structures. This can also involve examining the cervix to see if bleeding comes from the cervix besides the uterus.
Blood tests: this can involve checking haemoglobin and iron levels to look for anaemia or a bleeding disorder.
Swabs to rule out pelvic infection
Pregnancy test: this is to rule out miscarriage or ectopic pregnancy that can cause heavy bleeding.
Radiology imaging: Imaging tests such as ultrasound can help investigate abnormalities in the uterus such as fibroids or polyps.
Biopsy: A sample of the tissue from the lining of the uterus may be taken for further investigation to rule out any precancerous or cancerous changes.
Management and treatment of menorrhagia.
There are several approaches to treating menorrhagia however this will depend on the cause of the heavy menstrual bleeding and how severe it is, as well as the patient’s preference.
Hormonal treatment – hormonal medications, birth control pills and hormonal IUDs can help reduce heavy menstrual bleeding as well as regulate the menstrual cycle.
Tranexamic acid - a non-hormonal medication that can help reduce heavy menstrual bleeding by making the blood clot.
Non-Steroidal Anti-Inflammatory Drugs – can help reduce menstrual cramps and heavy bleeding.
Iron supplements to help with anaemia due to heavy bleeding and help address the iron deficiency
Dilation and curettage - only used as a diagnostic procedure in NZ where tissue from the lining of the uterus is obtained to check for infection, fibroids or cancer that may cause menorrhagia.
Myomectomy – refers to the surgical procedure of removing fibroids from the uterus which can decrease heavy menstrual bleeding related to the fibroids.
Hysterectomy – the surgical removal of the uterus – this should be the last resort for women who have severe heavy menstrual bleeding and do not wish to have any more pregnancies in future.
Endometrial ablation where the lining of the womb is removed.
Uterine Fibroid Embolization – a minimally invasive procedure and alternative to hysterectomy that involves shrinking fibroids by blocking their blood supply.
