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Heavy periods (menorrhagia): Treatment, symptoms, advice and help

About heavy periods (menorrhagia)

Menorrhagia is a gynaecological problem characterised by excessive bleeding during the menses. It may result from several local as well as systemic causes and can be usually treated satisfactorily.

Heavy periods (menorrhagia): Incidence, age and sex

Menorrhagia is a common gynaecological problem and can affect women at any age during her reproductive life. Heavy periods are usual at the onset of the menses during puberty (menarche).

Signs and symptoms of heavy periods (menorrhagia): Diagnosis

There is excessive menstrual bleeding. Sometimes the length of menstrual cycle may be shortened or may become irregular. There may also be inter-menstrual bleeding. There may also be associated lower abdominal pain. Excessive bleeding can lead to anaemia and the affected individual may experience weakness, giddiness and fatigue.

The evaluation of menorrhagia involves pelvic examination by a gynaecologist which may give some indication of a mass in the uterus or ovary. Ultrasonography of the abdomen is usually required to confirm the diagnosis of fibroid or ovarian mass. Diagnostic laparoscopy is sometimes done which involves visualisation of pelvic structures by a fibre-optic device inserted into the abdomen through a small incision. Evaluation of thyroid function by a blood test is generally needed to exclude hypothyroidism.

Causes and prevention of heavy periods (menorrhagia)

The commonest cause of menorrhagia is fibroid, which is a benign growth uterine wall. Other causes include benign and malignant tumours of uterus, endometriosis (gynaecological medical condition in women in which endometrial-like cells appear and flourish in areas outside the uterine cavity, most commonly on the ovaries)), trauma and hormonal disorders (hypothyroidism). Menorrhagia is usual at puberty and menopause. Sometimes, there is no discernable cause and it is due to imbalance in the action of female hormones (oestrogen and progesterone). This disorder is called dysfunctional uterine bleeding.

Heavy periods (menorrhagia): Complications

Blood loss due to menorrhagia can lead to anaemia and can cause discomfort due to general weakness, fatigue and shortness of breath. Sudden heavy blood loss can lead to hypovolemic shock which needs immediate resuscitative measures.

Heavy periods (menorrhagia): Treatment

The management of menorrhagia includes symptomatic relief and treatment of underlying cause. Symptomatic treatment involves iron and vitamin supplements to correct anaemia. Low dose hormone combinations or oral contraceptives can help to reduce bleeding and regularise menstrual cycles. Underlying local cause like fibroid or other uterine tumours usually need surgical management. This may involve surgical removal of tumour or removal of uterus (hysterectomy). Hypothyroidism can be treated by thyroid hormone replacement under medical supervision. Menorrhagia usually resolves with treatment of underlying cause and has a good prognosis.