Menometrorrhagia is a condition marked by abnormally heavy, prolonged, and irregular uterine bleeding. Women with this condition usually bleed more than 80 ml, or 3 ounces, during a menstrual cycle. The bleeding is also unexpected and frequent. For example, you’ll likely experience bleeding outside of when you’d expect your menstrual period to occur.
Menometrorrhagia is more commonly seen in woman age 40 and older.
Signs and symptoms of menometrorrhagia may include:
• Soaking through one or more sanitary pads or tampons every hour for several consecutive hours
• Needing to use double sanitary protection to control your menstrual flow
• Needing to wake up to change sanitary protection during the night
• Bleeding for longer than a week
• Passing blood clots larger than a quarter
• Restricting daily activities due to heavy menstrual flow
• Having back and abdominal pain during menstruation
• Symptoms of anemia, such as tiredness, fatigue or shortness of breath
There are numerous conditions that can cause abnormal uterine bleeding. Some of these include:
▪︎ Cancer or precancerous conditions.
• Endometrial cancer (uterine cancer)
• Endometrial hyperplasia, which is a thickening of the uterus’s lining
• Vaginal cancer
• Ovarian cancer
• Cervical cancer
• Uterine sarcoma
▪︎ Medical conditions.
• Systemic diseases like kidney or liver disease
• Celiac disease
• Blood clotting disorders
• Low platelet count
A penetrating or blunt injury to the vagina or cervix or sexual abuse can cause abnormal uterine bleeding.
Risk Factors –
Risk factors vary with age and whether you have other medical conditions that may explain your menorrhagia. In a normal cycle, the release of an egg from the ovaries stimulates the body’s production of progesterone, the female hormone most responsible for keeping periods regular. When no egg is released, insufficient progesterone can cause heavy menstrual bleeding.
Menorrhagia in adolescent girls is typically due to anovulation. Adolescent girls are especially prone to anovulatory cycles in the first year after their first menstrual period (menarche).
Menorrhagia in older reproductive-age women is typically due to uterine pathology, including fibroids, polyps and adenomyosis. However, other problems, such as uterine cancer, bleeding disorders, medication side effects and liver or kidney disease must be ruled out.
Excessive menstrual bleeding can have a significant impact on your health and quality of life. The significant loss of blood can lead to anemia.
• Severe abdominal pain
Along with heavy menstrual bleeding, you might have painful menstrual cramps (dysmenorrhea).
Sometimes the cramps associated with menorrhagia are severe enough to require medical evaluation.
Excessive menstrual bleeding can also be a symptom of some reproductive cancers and conditions that affect fertility.
Your doctor will most likely ask about your medical history and menstrual cycles.
Your doctor will do a physical exam and may recommend one or more tests or procedures such as:
• Blood tests.
A sample of your blood may be evaluated for iron deficiency (anemia) and other conditions, such as thyroid disorders or blood-clotting abnormalities.
• Pap test.
In this test, cells from your cervix are collected and tested for infection, inflammation or changes that may be cancerous or may lead to cancer.
• Endometrial biopsy.
Your doctor may take a sample of tissue from the inside of your uterus to be examined by a pathologist.
This imaging method uses sound waves to produce images of your uterus, ovaries and pelvis.
Based on the results of your initial tests, your doctor may recommend further testing, including:
During this test, a fluid is injected through a tube into your uterus by way of your vagina and cervix. Your doctor then uses ultrasound to look for problems in the lining of your uterus.
This exam involves inserting a thin, lighted instrument through your vagina and cervix into your uterus, which allows your doctor to see the inside of your uterus.
The treatment for menometrorrhagia will depend on the cause and on whether you want to become pregnant in the future.
Some medical options for treatment include:
• Nonsteroidal anti-inflammatory drugs (NSAIDs).
Medicines such as ibuprofen or naproxen sodium help reduce blood loss during your period. They can also help with painful cramps.
• Birth control pills.
Oral contraceptives can help regulate your menstrual cycles and reduce heavy or prolonged bleeding.
This hormone may be used to correct a hormone imbalance and reduce heavy bleeding.
• Tranexamic acid.
This medicine helps reduce menstrual bleeding. It only needs to be taken when you are bleeding.
• Hormonal intrauterine device (IUD).
IUDs release a type of progestin called levonorgestrel. This makes the uterine lining thin and decreases menstrual blood flow and cramping.
• Stopping or changing hormonal medicine.
If your hormone medicine causes abnormal uterine bleeding, your doctor may change or stop your hormone treatment.
• Iron supplementation.
If you have anemia, which is a low iron level, or iron levels that are low but not yet anemic, your doctor may suggest that you take iron supplements.
Some causes of menometrorrhagia are best treated with surgery. Depending on the underlying cause, surgical options may include:
• Uterine fibroid embolization.
This surgery gets rid of fibroids by cutting off their blood supply. Tiny particles are put into the uterine arteries. This causes the fibroids to shrink.
This surgery gets rid of the fibroids but keeps the uterus intact. Women can still become pregnant naturally after this procedure.
• Uterine ablation.
For women who do not want to become pregnant in the future, uterine ablation may be the best option. In this surgery, the lining of the uterus is destroyed. This can be done with laser, heat, electricity, microwave energy, or freezing.
If hormone treatment fails to control abnormal uterine bleeding, your doctor may suggest removing your uterus as a last resort. A hysterectomy may also be necessary if cancer is the cause of your menometrorrhagia. This may be followed by radiation or chemotherapy.
According to Ayurveda, menometrorrhagia is compared with Rakta Pradar or Asrigdara. Ayurveda believes that it is caused due to the aggravation of the pitta dosha along with the vata dosha.
Line of treatment adopted in Asrigdara is Stambhana Chikitsa and sheetala Chikitsa.
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