MENORRHAGIA

 Menorrhagia is one of the most common forms of irregular periods.

 It is the most common type of abnormal uterine bleeding characterized by heavy and prolonged menstrual bleeding. In some cases, bleeding may be so severe and relentless that daily activities become interrupted.

 Any woman of childbearing age can develop menorrhagia. However, some women are likely to experience heavier menstrual bleeding than others. Risk factors include:

• being a young adolescent or pre-menopausal woman
• being overweight
• using certain medications, such as blood thinners
• having a hereditary bleeding disorder
  

Causes-

In some cases, the cause of heavy menstrual bleeding is unknown, but a number of conditions may cause menorrhagia. Common causes include:

• Hormonal imbalance- In a normal menstrual cycle, a balance between the hormones estrogen and progesterone regulates the buildup of the lining of the uterus (endometrium), which is shed during menstruation. If a hormonal imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding.
• Dysfunction of the ovaries- Lack of ovulation (anovulation) may cause hormonal imbalance and result in menorrhagia.
• Uterine fibroids- These noncancerous (benign) tumors of the uterus appear during your childbearing years. Uterine fibroids may cause heavier than normal or prolonged menstrual bleeding.
• Polyps- Small, benign growths on the lining of the uterine wall (uterine polyps) may cause heavy or prolonged menstrual bleeding. Polyps of the uterus most commonly occur in women of reproductive age as the result of high hormone levels.
• Adenomyosis- This condition occurs when glands from the endometrium become embedded in the uterine muscle, often causing heavy bleeding and pain. Adenomyosis is most likely to develop if you're a middle-aged woman who has had many children.
• Intrauterine device (IUD)- Menorrhagia is a well-known side effect of using a nonhormonal intrauterine device for birth control. When an IUD is the cause of excessive menstrual bleeding, you may need to remove it.
• Pregnancy complications- A single, heavy, late period may be due to a miscarriage. If bleeding occurs at the usual time of menstruation, however, miscarriage is unlikely to be the cause. An ectopic pregnancy - implantation of a fertilized egg within the fallopian tube instead of the uterus - also may cause menorrhagia.
• Cancer- Rarely, uterine cancer, ovarian cancer and cervical cancer can cause excessive menstrual bleeding.
• Inherited bleeding disorders.-Some blood coagulation disorders - such as von Willebrand's disease, a condition in which an important blood-clotting factor is deficient or impaired - can cause abnormal menstrual bleeding.
• Medications- Certain drugs, including anti-inflammatory medications and anticoagulants (to prevent blood clots), can contribute to heavy or prolonged menstrual bleeding. Improper use of hormone medications also can cause menorrhagia.
• Other medical conditions- A number of other medical conditions, including pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease, may cause menorrhagia
  

Symptoms-

In general, bleeding is considered excessive when a woman soaks through enough sanitary products (sanitary napkins or tampons) to require changing every hour. In addition, bleeding is considered prolonged when a woman experiences a menstrual period that lasts longer than seven days in duration.

The following are the most common (other) symptoms of menorrhagia. However, each individual may experience symptoms differently. Symptoms may include:

• Spotting or bleeding between menstrual periods
• Spotting or bleeding during pregnancy

The symptoms of menorrhagia may resemble other menstrual conditions or medical problems. Always consult a physician for a diagnosis.

Complications-

Excessive or prolonged menstrual bleeding can lead to other medical conditions, including:

• Iron deficiency anemia: In this common type of anemia, there is decrease in hemoglobin. Low hemoglobin may be the result of insufficient iron. Menorrhagia may deplete iron levels enough to increase the risk of iron deficiency anemia. Signs and symptoms include pallor, weakness and fatigue.

Although diet plays a role in iron deficiency anemia, the problem is complicated by heavy menstrual periods. Most cases of anemia are mild, but even mild anemia can cause weakness and fatigue. Moderate to severe anemia can also cause shortness of breath, rapid heart rate, light-headedness and headaches.

• Severe pain: Heavy menstrual bleeding often is accompanied by menstrual cramps (dysmenorrhea). Sometimes the cramps associated with menorrhagia are severe enough to require prescription medication or a surgical procedure.
  

Differential Diagnosis-

• Pregnancy complications:

• Ectopic pregnancy
• Incomplete abortion
• Miscarriage
• Threatened abortion

• Non-uterine bleeding:

• Cervical ectropion/erosion
• Cervical neoplasia/polyp
• Cervical or vaginal trauma
• Condylomata
• Atrophic vaginitis
• Foreign bodies
• Pelvic inflammatory disease (PID)
• Endometritis
• Tuberculosis

• Hypothyroidism
  

Investigations-

Diagnosis begins with a gynecologist evaluating a patient's medical history and a complete physical examination including a pelvic examination. A diagnosis of menorrhagia can only be certain when the physician rules out other menstrual disorders, medical conditions, or medications that may be causing or aggravating the condition. Other diagnostic procedures for menorrhagia may include the following:

1. Blood tests
   
2. Pap test - test that involves microscopic examination of cells collected from the cervix; used to detect changes that may be cancerous or may lead to cancer, and to show non-cancerous conditions, such as an infection or inflammation.
   
3. Ultrasound (Also called sonography.) - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
   
4. Biopsy (endometrial) - a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present.
   
5. Hysteroscopy - a visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.
   
6. Dilation and curettage (D & C) - a common gynecological surgery which consists of widening the cervical canal with a dilator and scraping the uterine cavity with a curette.

Treatment-

Specific treatment for menorrhagia will be determined by the physician based on:

• age, overall health, and medical history
• extent of the condition
• cause of the condition
• tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition

Treatment for menorrhagia may include:

• Iron supplementation (if the condition is coupled with anemia, a blood disorder caused by a deficiency of red blood cells or hemoglobin)
• Prostaglandin inhibitors such as nonsteroidal anti-inflammatory medications (NSAIDs), such as aspirin or ibuprofen (to help reduce cramping and the amount of blood expelled)
• Oral contraceptives (ovulation inhibitors)
• Progesterone (hormone treatment)
• Endometrial ablation - a procedure to destroy the lining of the uterus (endometrium).
• Endometrial resection - a procedure to remove the lining of the uterus (endometrium).
• Hysterectomy - surgical removal of the uterus.

Role of Homoeopathy-

Homeopathic remedies bring about natural relief. Menstrual problems that are chronic or severe are best addressed with the guidance of an experienced practitioner: a constitutional remedy can help to bring balance to a person's system on many levels, not just a particular symptom. Homeopathy can heal menorrhagia completely by reducing the frequency and intensity.

Please E-mail dr_ramanand@rediffmail.com for any questions/treatment