- Physical examination
- Blood tests: To evaluate for iron deficiency (anaemia) and other conditions, like thyroid disorders or blood-clotting abnormalities.
- Pap test: This involves collecting cells from the cervix and testing for infection, inflammation or changes that may be cancerous or that may lead to cancer.
- Endometrial biopsy
- Ultrasound X-ray.
- Sonohysterography: A fluid is injected through a tube into the uterus through the vagina and cervix. An ultrasound is then used to look for problems in the lining of the uterus.
- Hysteroscopy: This involves the insertion of a thin, lighted instrument through the vagina and cervix into the uterus. This allows the doctor to see the inside of the uterus.
- Dilation and curettage: Although used for treatment, it can also detect abnormalities.
- Menorrhagia treatment by medical therapy may include:
- The use of non-steroidal anti-inflammatory drugs (NSAIDs).
- The use of tranexamic acid.
- Oral contraceptives.
- Oral progesterone.
- Hormonal intrauterine device.
- Iron supplements regularly.
- Dilation and curettage (D&C): In a D&C, the cervix is opened up (dilate) and tissue from the lining of the uterus is scraped or suctioned to reduce menstrual bleeding.
- Uterine artery embolization: This is chosen if the menorrhagia is caused by fibroids. The aim of this procedure is to shrink the fibroids in the uterus through blockage of the uterine arteries and cutting off their blood supply.
- Focused ultrasound surgery: This is also used to treat menorrhagia caused by fibroids by shrinking the fibroids. This technique uses ultrasound waves to destroy the fibroid tissue.
- Myomectomy: Surgical removal of uterine fibroids.
- Endometrial ablation: Destroying (ablating) the lining of the uterus (endometrium). This procedure makes use of laser, radiofrequency or heat, which is applied to the endometrium to destroy the tissue.
- Endometrial resection: The use of an electrosurgical wire loop to remove the lining of the uterus.
- Soaked one or more sanitary pads or tampons every hour, for several consecutive hours.
- Needing to use double sanitary pads to control menstrual flow.
- Needing to change sanitary protection during the night.
- Bleeding for more than a week.
- Passing blood clots bigger than a quarter size.
- Have restricted daily activities due to heavy menstrual flow.
- Symptoms of anaemia; like tiredness, fatigue or shortness of breath.
- Constant pelvic and lower abdominal pain
In certain cases, the cause of heavy menstrual bleeding is usually unknown, but a number of conditions may be responsible for menorrhagia. Common menorrhagia causes include:
- Hormone imbalance: Hormone imbalance causes the endometrium to develop in excess, which shed by way of heavy menstrual bleeding.
- Dysfunction of the ovaries: This could lead to hormone imbalance, which may result in menorrhagia.
- Uterine fibroids: This may cause a period heavier than normal or prolonged menstrual bleeding.
- Adenomyosis: This is a condition that occurs when glands of the endometrium become entrenched in the uterine muscle. This often cause heavy bleeding and painful periods.
- Intrauterine device (IUD): Menorrhagia is a recognized side effect of non-hormonal intrauterine device used for birth control.
- Could be due to pregnancy complications.
- Cancers, such as uterine cancer and cervical cancer, may cause excessive menstrual bleeding.
- Inherited bleeding disorders, such as von Willebrand's disease, can cause abnormal menstrual bleeding.
- Medications: Certain medications, such as anti-inflammatory medications, hormonal medications and anticoagulants can contribute to heavy or prolonged menstrual bleeding.
- Certain medical conditions: such as liver, thyroid or kidney disease may be associated with menorrhagia.
What are the likely risk factors for menorrhagia?
The following are the possible risk factors for menorrhagia:
- Certain medical conditions: such as, bleeding disorders, uterine cancer, kidney disease or liver disease.
- Hormonal imbalance such as insufficient progesterone.
- Uterine pathology; such as fibroids, polyps and adenomyosis.
- Side effects of certain medication.
What are the complications that may result from menorrhagia?
Prolonged or heavy menstrual bleeding can lead to other medical conditions, such as:
- Iron deficiency anaemia.
- Severe pain.
What are self-care tips to manage menorrhagia?
There are some self-care practices that could help deal with menorrhagia:
- Bed rest when experiencing heavy bleeding.
- Regularly change tampons, twice a day at least.
- Use menstrual products specially designed for heavy flow.
- Double up – wear two pads together, or a pad and a tampon.
- You can try a menstrual cup. It holds more blood flow than a tampon or pad.
- Wear dark clothing to camouflage any leaks.
- Stockpile extra menstrual products and underwear in your purse, car, and office desk.
Is menorrhagia common?
Around 11.4 to 13.2 percent of women suffer this disorder.