Menorrhagia is defined by blood loss of over 80ml (twice the normal amount) each cycle. Most women have a clear idea of how heavy their periods should be. The best measure is the level of disruption to your everyday life, the change from what you consider is normal for you, and whether you feel you use an unusually high number of pads or tampons. If you are flooding through to clothes or bedding or needing to use tampons and towels together, this is also an indication of excessive blood loss.

What is the causes of Menorrhagia?

In many cases there is no obvious cause.

Known causes include:

• Dysfunctional uterine bleeding (DUB) (a hormonal problem)
• Cervical or endometrial polyps (benign outgrowth of the lining of the cervix or womb cavity)
• Endometriosis (womb lining tissue in place in the pelvis where it should not normally be)
• Fibroids (benign enlargements of the smooth muscle wall of the womb)
• Hypothyroidism (underactive thyroid gland) or Hyperthyroidism

Occasional causes

• Puberty or start of the menopause
• Intrauterine contraceptive device – ‘the coil’
• Cystic glandular hyperplasia (also called metropathia haemorrhagica -problem of the womb lining)
• Chronic pelvic inflammatory disease (ongoing infection in the pelvis)
• Hyperthyroidism (overactive thyroid gland)
• Polycystic ovarian syndrome (PCOS)

Rare causes

• Adrenal disorders
• Liver or kidney disease
• Blood disorders
• Endometrial carcinoma (cancer of the womb lining)
• Tuberculous endometritis (tuberculosis of the womb lining)

Heavy periods are sometimes caused by medical treatments, such as anticoagulant drugs (to reduce the clotting of the blood)and chemotherapy (drug treatment for cancer).

The Diagnosis of Menorharrgia.

Diagnosing the cause of heavy periods involves a careful general medical history to explore possible background causes, and physical examination including a vaginal examination to check for polyps and womb enlargement.

You might be asked to fill in a chart estimating your blood loss, or to describe how often you need to change your sanitary pads (towels and tampons).

Blood tests can help to detect anaemia, which can be caused by prolonged heavy periods, thyroid problems, and menopause. Blood tests are usually done if the diagnosis is not obvious.

Ultrasound examination of the womb is very helpful in detecting fibroids, polyps inside the womb, and some forms of cancer. This is usually done with a transvaginal scan, when a small scanner is inserted into the vagina, to take a close-up scan of the womb.

If no obvious cause is found that can be treated by a GP, referral to a gynaecologist for further investigations is necessary. This usually involves taking a small sample (biopsy) of the womb lining, for examination under microscope.

The Treatment

There are several treatment options available for heavy periods, ranging from medicines to surgery.

The best medicine for reducing blood loss is tranexamic acid tablets. This works to reduce the breakdown of blood clots, leading to less bleeding, and should be taken several times a day for 3 to 4 days during a period. It does not reduce the duration of bleeding. Anti-inflammatory medicines are another option. They are less effective than tranexamic acid in reducing blood loss but, unlike tranexamic acid, they do ease period pain.

Some contraceptive methods can also help to ease heavy painful periods whilst preventing pregnancy (although they are not the first choice treatment specifically for heavy periods). These include the contraceptive pill, intrauterine system (IUS), and long-acting progestogens delivered by injection or implanon.

Surgical options include the removal of the womb (hysterectomy) or removal of the lining of the womb (called the endometrium – this procedure is known as endometrial ablation or endometrium resection). Obviously, hysterectomy completely cures heavy periods, but is be a major operation, prevents conception and has a significant recovery time.

Endometrial ablation or resection has varying degrees of success (heavy bleeding may return in the future), but depending on the surgical method used, it may be more effective if the womb lining is thinned by certain medicines before the operation takes place.

Endometrium resection can be done in most major hospital in Malaysia.