Uterine Conditions: Menorrhagia

Uterine Conditions: Menorrhagia²²
If you have heavy, prolonged or irregular periods, or you bleed between periods, but you aren't diagnosed with fibroids or another condition, a hormonal imbalance may be responsible. Known as menorrhagia or dysfunctional uterine bleeding, this condition is most common among women over age 45, although it can also affect adolescent girls who are beginning to menstruate.

Causes. Menorrhagia often stems from an imbalance of the hormones that control menstruation, resulting in "anovulatory bleeding," or menstruation without ovulation. Without ovulation and sufficient levels of progesterone, the uterine lining (endometrium) continues to grow, becoming thicker than usual and causing abnormally heavy bleeding. Also, without progesterone, the endometrium lacks structural support and sloughs off irregularly, causing heavy bleeding, irregular periods or both.

Anovulatory periods can occur in women who take oral contraceptives or estrogen therapy. Menorrhagia is also associated with polycystic ovary syndrome (the accumulation of many incompletely developed follicles in the ovaries).

Women who ovulate can also experience menorrhagia. In such cases, the cause is too much progesterone, and while bleeding is regular, it may be abnormally heavy. This may occur in women who take progesterone-only contraceptives.

Other causes include blood clotting problems, and problems with ovulation resulting from stress, weight changes, thyroid abnormalities and certain medications.

Symptoms. The amount and frequency of abnormal or excessive bleeding can vary and change over time. If you need to change tampons or pads every one or two hours (or use more than 10 tampons or pads per day) or have a period that lasts longer than seven days, you are probably experiencing menorrhagia. You may also experience cramping or pelvic pain, significant fatigue, anemia (low blood iron), sadness or nervousness with menorrhagia.

Diagnosis. Before being diagnosed with menorrhagia, your health care professional should rule out fibroids, polyps, cancer, damage from an intrauterine device (IUD), a tubal pregnancy and pelvic inflammatory disease (PID). (For more information on PID, click here.)

Treatment. The first line of treatment for menorrhagia is generally hormone therapy-typically oral contraceptives or progesterone therapy-to normalize menstrual bleeding. Some medications, such as ibuprofen, may also relieve excessive bleeding and cramps. Surgical options, in addition to hysterectomy, for treating menorrhagia include:

Endometrial ablation. This minimally invasive procedure uses electricity, heat or freezing to destroy the lining of the uterus to reduce or stop heavy bleeding. Endometrial ablation is only for women who have finished having children because a subsequent pregnancy would be considered extremely high risk. Unlike a hysterectomy, ablation can be performed with local anesthesia. It is usually done in the hospital on an outpatient basis.
Dilation and curettage (D&C). During a D&C, the uterine lining is scraped away. Once a mainstay in the treatment of excessive menstrual bleeding, newer options are now considered more effective. Many health care professionals no longer recommend a D&C because it's not a long-term solution- heavy bleeding is likely to return after just a few menstrual cycles.

Prevention. There is no way to prevent menorrhagia.