By Dr Ananya Mandal, MD
Menorrhagia literally means regular menstruation but with excessive blood flow and duration. It is one the commonest gynaecologic complaints. The interval between two cycles remains constant.
Normal menstrual cycle
A normal menstrual cycle is 21-35 days with an average of 7 days of flow measuring 25-80 mL.
Menorrhagia is defined as total blood loss exceeding 80 mL per period usually lasting longer than 7 days. (1)
Anatomy of the uterus
The uterus or the womb is lined by a layer of mucus called the endometrium.
Depending on the variation is hormone levels during the menstrual cycle the endometrium first builds up after every monthly period and then its blood supply increases so that a fertilized egg cell can settle in the uterus and grow there to become a baby.
However, if the egg is not fertilized the endometrium undergoes shedding in the next period.
The period thus involves loss of both blood and the endometrial tissues.
The menstrual blood on the pad or tampon is normally only about 20 to 60 ml of blood (only 4 to 12 teaspoons).
At normal rates it takes about 4 hours for a regular tampon or pad to become full. Some days of the period may be heavier than others. (2, 3)
Frequency of Menorrhagia
The World Health Organization estimates that approximately 18 million women between ages 30 and 55 years feel that they have Menorrhagia.
Of these 10% women may have blood flow severe enough to cause anemia and truly fall under the diagnosis of Menorrhagia.
It is difficult to measure the exact amount of blood loss and diagnosis is usually dependent on patient's history. (1)
Disorders of menstruation
Disorders of menstruation that must be differentiated from Menorrhagia (1) –
Menorrhagia is different from other common gynaecological disorders. These include –
- Metrorrhagia (flow at irregular intervals – shortened or lengthened intervals between periods)
- Menometrorrhagia (frequent and excessive blood flow)
- Polymenorrhea (bleeding at intervals of less than 21 days)
- Dysfunctional uterine bleeding or DUB (abnormal uterine bleeding without any obvious structural or systemic abnormality – seen in menopausal women with underlying pathology)
Menorrhagia is basically a symptom of an underlying gynaecological condition. It may be seen as first symptoms in women with endometriosis, fibroids, and sometimes medications. (2, 3)
Symptoms of Menorrhagia
Menorrhagia can be suspected if a woman complains (1-3) –
- Soaking through a pad or tampon in an hour (or sometimes even lesser)
- Weakness and tiredness easily especially along with heavy periods
- Plenty of blood clots in the menstrual flow.
Menorrhagia may sometimes affect social life as well and also affect day to day activities. Some women also suffer from mood swings and/or anxieties. There may be problems with sleeping as well. (2)
Surgical and medication may be offered for therapy. Usually therapy is directed towards treating the underlying condition rather than the symptom of heavy periods that often resolves if the pathology underlying Menorrhagia is addressed.
Edited by April Cashin-Garbutt, BA Hons (Cantab)