Menorrhagia is a condition in which the menstrual period takes an abnormally long time.
Professor Mordechai Goldenberg – specialist in endoscopic surgery. Head of gynecological surgery, Chaim Sheba Hospital (Tel Hashomer), Head of the Endoscopic surgery School
Increased menstrual bleeding may be the result of abnormal blood clotting, hormonal regulation of the menstrual cycle or endometrium. Menstrual bleeding can be increased without any other symptoms or in combination with other symptoms such as severe pain (dysmenorrhoea).
The normal menstrual cycle lasts 25-35 days and the bleeding – an average of 5 days. The amount of blood which thus loses female is 25 to 80 ml. Blood loss of more than 80 ml or cycle that lasts more than 7 days can cause menorrhagia. In practice patient or doctor can not measure the amount of blood lost. It is possible to estimate the amount of bleeding on the number of pads or tampons used by women during the menstrual cycle. Well soaked tampon containing 5 ml of blood. In the case of low blood volume, but the length of the cycle for more than seven days, you must consult a doctor for gynecological consultation. This may indicate a manifestation of menorrhagia.
Causes of menorrhagia
Distribution of the endometrium (endometriosis).
In most cases bleeding is the result of natural hormonal changes leading to menopause.
Irritation of the mucosa of the uterus can lead to increased blood flow, for example as a result of infection (acute inflammatory disease or chronic pelvic infection) or intrauterine devices (IUDs).
Fibroids (leiomyomas) on the wall of the uterus sometimes cause the intensity of menstrual loss by increasing the surface of the uterus. Exceptions, such as adenomyosis, endometrial increase the uterus and make it sensitive.
Important note: Endometriosis causes pain but usually does not cause changes in blood loss during menstruation.
Carcinoma of the uterus (endometrial carcinoma) usually causes irregular bleeding, unlike the cyclic pattern of menorrhagia.
Ovarian endocrine disease (uterine bleeding, the most common cause)
Blood clotting problems (rare)
Risk factors: obesity, lack of ovulation
Diagnosis of menorrhagia
– Examination of the pelvis and rectum
– Cervical smear
– Ultrasound scan of the pelvis is the first line diagnostic tool to determine the structural anomalies
– Endometrial biopsy to rule out cancer or atypical hyperplasia
Treatment of menorrhagia
Generally, treatment is directed to a mechanism causing menorrhagia and parallel to the treatment of symptoms.
Often this treatment with hormones. Typically, the patient is recommended to take contraceptive pills or progesterone drugs for several months.
Hormone therapy helps to restore hormonal balance and is effective in reducing bleeding without surgery. This treatment is suitable for women who want to preserve their reproductive function in the future to have a baby. Preparations need to take a long time. During the reception there may be minor side effects such as headaches, breast tenderness and weight gain. Efficacy is relatively limited.
Fibroids can respond to hormonal treatment. If not, then maybe it would have to be surgically removed.
In the treatment may also be used non-steroidal anti-inflammatory drugs (NSAIDs), but they tend to reduce the bleeding intensity by 30% only.
Curettage. Sometimes recommended to women who do not respond to medication. This method consists in a mechanical scraping the mucous membrane of the uterus under general anesthesia. This reduces bleeding. The method is still used in cases of severe bleeding that requires immediate treatment.
Hysteroscopy. Surgical procedure in which you are addressing the causes and treatment of menorrhagia endometrial using an optical device (hysteroscope), which allows the doctor to view the uterus during the procedure. By hysteroscopy can be removed small fibroids is localized out of muscular layer of the uterus. The procedure is performed under general anesthesia and requires a highly qualified doctor as high risk (75-85%), perforation of the uterus, bleeding and infection.
Hysterectomy. Effective treatment for menorrhagia may be a hysterectomy (removal of the uterus surgically by open surgery or laparoscopy under general anesthesia). After surgery 3-4 day hospitalization and recovery within a few weeks.
But hysterectomy performed only in cases where it is impossible to remove fibroids locally and preserve the uterus. Our specialists have appliances conserving surgery and do everything possible to avoid a hysterectomy.
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Benign tumors of the uterus (fibroid)
Amenorrhea (absence of menstruation)
Dysmenorrhea (painful menstruation)
Vaginal infections (vaginitis), including fungal, bacterial, protozoal and viruses
Cancer and precancerous genital conditions including ovaries, fallopian tubes, uterus,cervix, vulva