A long and heavy menstrual period is called menorrhagia in gynecology. A lot of mucous membrane builds up during the monthly cycle and long and heavy bleeding occurs during menstruation. The opposite of menorrhagia is oligomenorrhea (short and weak menstrual bleeding).
What is menorrhagia?
The monthly cycle of a woman of childbearing age is usually twenty-eight days. Four to seven days of this, the woman has her monthly menstrual period, during which the tissue built up over the month for pregnancy is shed. If this pregnancy does not occur, this now superfluous tissue is removed again under complicated hormonal processes. This process is repeated from the first menstrual period in early puberty to the last one before menopause. Most women have little discomfort with monthly bleeding, but some experience heavy, painful bleeding. This can be due to various reasons such as benign and malignant changes in the uterus or endometriosis. But menorrhagia also occurs due to hormonal imbalances and an altered state of the uterus after multiple births or abortions.
Causes
If cysts, abscesses or tumors have formed on and in the uterus, increased menstruation may occur. However, even preliminary stages of cancer can cause this symptomatology. Endometriosis is a special case of menstrual disorders. In this case, due to hormonal disorders, uterine tissue is built up throughout the woman’s body. This severe and chronic disease must be monitored and treated by a gynecologist. Hormonal disorders can lead to increased menstrual bleeding, with an imbalance between progesterone and estrogen. Women who have had several children tend to have increased and prolonged menstruation. The uterus is usually enlarged and builds up too much tissue during the cycle. The same symptoms often occur in women who have had one or more miscarriages. In addition, infections with viruses, fungi, bacteria and protozoa can also cause menstrual irregularities.
Symptoms, complaints, and signs
Menorrhagia is characterized by long and heavy menstrual bleeding, with blood loss exceeding 80 milliliters. Normally, this averages 60 milliliters. The higher loss of blood in menorrhagia is caused by a longer extension of the bleeding phase, which is between 7 and 14 days. Often the bleeding is also heavier at the same time. With a combination of a long bleeding period and heavy bleeding, a woman may lose up to 150 milliliters of blood during this phase. While it is not a life-threatening condition, the constant blood loss can severely limit quality of life. Symptoms most commonly observed are chronic fatigue, exhaustion and exhaustion. Circulatory problems can also occur, with blood pressure often too low. Blood loss also leads to anemia because the body’s own blood cannot be replenished as quickly. Since iron is an intrinsic component of hemoglobin, blood loss also causes iron loss at the same time. This also inhibits further blood formation. As a result of anemia, there is also an increase in susceptibility to infection. In some cases with severe blood loss, the discharge of thick blood clots is also observed. In addition to fatigue and listlessness, for many women menorrhagia often becomes a burden in everyday life, at work and especially in their sexual life. As a result, depression and psychological problems may also occur.
Diagnosis
As with all disease diagnosis, the doctor-patient discussion, i.e. the anamnesis, is the first priority in the case of menorrhagia. In the further course, the physician may then use the following examination methods, depending on the suspicion and indications:
- Palpation examination
- Ultrasound
- Pregnancy test
- Examination of the cervix and vagina
- Cancer examination by means of smear and colposcopy
- Magnetic resonance imaging (MRI) or computed tomography (CT).
- Blood test
- Examination of the hormonal balance
Complications
Complications of menorrhagia may result from severe blood loss.In the case of both very heavy and very long menstrual bleeding, women can lose so much blood that circulatory problems can be the result. Since these do not have any fundamental medical significance, mild circulatory problems do not require separate medical treatment. Iron deficiency can be more serious. Severe blood loss causes iron levels to drop rapidly. If the iron level falls below 12, symptoms such as pallor, fatigue, concentration problems and general weakness may occur. An iron deficiency also favors the occurrence of infections, as the immune system‘s performance is reduced in the event of a permanent iron deficiency. Iron has important functions in the area of blood formation and should therefore be substituted accordingly. However, since an oversupply of iron to the body can be just as critical as a deficiency, an iron deficiency should also be diagnosed before taking appropriate preparations. In the context of menorrhagia, gynecological screening should be used. In rare cases, menorrhagia is a consequence of a tumor in the tissue of the uterus, which is then accompanied by complications such as infertility or spread to other organs.
When should you go to the doctor?
Menorrhagia is not only unpleasant, but also a reason to see a doctor. Even when it occurs for the first time, medical attention should be sought to determine why menstruation has lasted so long. The causes are often treatable, but if they are ignored, menorrhagia will recur again and again, placing a significant burden on the patient’s health in the long term. The doctor will first ask how often menorrhagia has already occurred, whether other symptoms and complaints have occurred in the meantime, and whether anything has changed in the discharge itself. Depending on the suspicion, blood or tissue samples are then taken to find out whether it is a tissue change or a hormonal disorder. In connection with a newly taken hormonal contraceptive, it may already help to discontinue it in consultation with the gynecologist and try an alternative instead. If menorrhagia occurs, there is no reason why you should not see your doctor while the bleeding is still in full swing. This is not a problem for an exam, and there are plenty of opportunities in the doctor’s office for patients to clean up after the exam.
Treatment and therapy
The different causes of menorrhagia require different treatment. First, the doctor will try to make the excessive bleeding stop by using medication. If cysts or cancer are suspected, tissue samples are taken afterward or possibly while the bleeding is still occurring and examined in a laboratory. Depending on the results, cysts are removed or surgery to remove cancerous growths must be performed. This may also be followed by chemotherapy or radiation. At the slightest suspicion of cancer, the gynecologist will act very quickly, as metastases can form from scattered tissue. If the menorrhagia is caused by hormonal disorders, the doctor will try to treat it with hormonal preparations or homeopathic medicines. In addition, taking the so-called birth control pill, which reduces menstrual bleeding to a minimum, may be considered in this case. In women who have given birth several times or who have suffered abortions, it is necessary to consider scraping the uterus. In this procedure, excess tissue is removed to allow the mucosa to rebuild completely. However, this method is now used only in rare cases because of the formation of scars in the uterus, which can further aggravate menorrhagia. In the case of infectious diseases of the reproductive organs, the gynecologist will treat with oral and local medications according to the underlying condition, and the sexual partner must usually be treated as well.
Outlook and prognosis
In menorrhagia, further health development is largely tied to the cause of the long and heavy menstrual period. There may be a favorable as well as a very unfavorable prognosis. If the course of the disease is favorable, the cause can be found in the area of emotional discomfort.In the case of high sensitivity and the presence of various stressors, relief of the symptoms often already occurs when an improvement in lifestyle takes place, a change in thinking takes place and psychotherapeutic help is used. Spontaneous healing is not necessarily to be assumed in this disorder. It can occur if the bleeding is coupled to the experience of a temporary exceptional situation. However, if the course of the disease is unfavorable, it may also lead to premature death. Menstrual bleeding disorder may indicate the presence of cancer. If medical care is not initiated, or if cancer treatment is not received until the disease is at an advanced stage, patients are at risk of a shortened average lifespan. In the case of other tissue changes such as cysts or abscesses, freedom from symptoms is usually achieved if these are completely removed in a surgical procedure. During life, menstrual irregularities may recur until the onset of menopause. The prognosis remains unchanged if symptoms recur.
Prevention
There are preventive measures to prevent some forms of menorrhagia. Responsible use of contraception can spare women from miscarriage. Breastfeeding the infant after birth directly affects the regression of the uterus to a normal size. Infections of the urogenital tract are very often caused by changing sexual partners and lack of hygiene. Infection with the HP virus can be prevented by vaccination or condoms. Regular checkups of the vagina, uterus and ovaries save many women from cancer or it is detected early and treated in time.
Follow-up care
Long and heavy menstrual periods can be accompanied by above-average blood loss. The acute consequences can be sometimes severe circulatory problems. Affected individuals then complain of nausea, dizziness, rapid heartbeat and severe drowsiness. This can lead to complications in everyday situations such as driving or make it difficult to concentrate on one’s job. Those who lose blood often and for long periods may also develop iron deficiency. Therefore, follow-up focuses on compensating for blood loss. To this end, affected women should regularly have the relevant blood values clarified by their gynecologist. Special preparations can compensate for an iron deficiency and thus prevent long-term consequences. Mennorhagia can also lead to complications in the emotional experience. Long and heavy bleeding can severely restrict the daily lives of those affected and make social situations difficult. Social withdrawal and even depression can result as complications in the psychological sphere. In this context, it may be useful to consult extensively with the attending physician. Also from these points of view it is important to have a mennorhagia medically clarified and specifically treated.
What you can do yourself
In addition to physical causes, psychological stress can also trigger menorrhagia. A healthy lifestyle with a balanced diet and regular exercise in the fresh air, learning relaxation techniques to reduce stress and getting enough sleep positively influence the menstrual cycle and improve mental and physical well-being. Herbal medicine knows numerous medicinal herbs, which are mostly used as tea preparation against heavy and long menstrual periods: These include lady’s mantle, shepherd’s purse, monk’s pepper and raspberry leaves. Cinnamon, cayenne pepper and coriander seeds can be used as a spice or infusion to help against heavy bleeding. In menorrhagia, care should be taken to ensure adequate intake of magnesium, iron, and vitamins B, C, and E, as these micronutrients affect the production and function of hormones and blood cells. Vitamins and minerals are abundantly contained in fresh fruits and vegetables, legumes, whole grain products and nuts – dietary supplements should only be used in exceptional cases. Supportive cold compresses reduce blood flow and pain: they can be applied to the lower abdomen up to four times a day for about 15 minutes. If cold application to the abdomen is considered unpleasant, foot baths with cold water or cooling calf compresses are an alternative.Anti-inflammatory painkillers from the pharmacy can also reduce blood flow. If self-treatment shows no effect, a gynecologist should be consulted.
