Menorrhagia (Abnormal Uterine Bleeding)

What Is Menorrhagia?

Menorrhagia is the term for very heavy and/or prolonged menstrual bleeding. This is a common issue and you should be referred to a gynecologist if the bleeding is such that it is impacting your quality-of-life, especially if you are struggling with anemia.

Diagnosis

The assessment usually includes a history to rule out medical causes of abnormal bleeding, a review of a pelvic ultrasound, and a physical exam to find any structural lesions in the uterus or cervix. Typically, we are looking for a bulky uterus that suggests fibroids, a benign muscular growth, or an adenomyosis– a disorder where glandular endometrial tissue is trapped inside the muscle of the uterus. In women over 40 years of age, we will often attempt to obtain an endometrial biopsy to rule out abnormal cells in the uterus lining that could be giving rise to the heavy bleeding.

Bloodwork is helpful in the assessment of anemia, ferritin stores, updated thyroid function, and blood coagulation profile.

Treatment

Once a medically treatable or reversible reason for the abnormal bleeding is ruled out, then we can address the bleeding on its own with common medical or surgical options. Watchful waiting, or expectant management, is appropriate for some people who aren’t experiencing severe bleeding and want to wait and see whether their bleeding improves without treatment.

Medication

If we need to further treat menorrhagia, there are several medication options including:

• Tranexamic acid
• Estrogen and progestin containing hormonal therapies such as the birth control pill
• Progestin therapies such as the mini pill, Depo-Provera, or the Mirena IUCD.
• Other therapies such as Lupron, Fibristal, or Danazol if people have contraindications to the use of the other treatments.

Surgery

Surgical options include minimally invasive treatment to alleviate bleeding. The endometrial ablation procedure is particularly appealing for people who want very little down time after their procedure. At Blossom, we can arrange for a Novasure endometrial ablation to be done in the Operating Room, a procedure which employs cautery. However, we also have capability to use a hysteroscope and resect fibroids and polyps as well.

For a definitive surgical treatment, hysterectomy is an option. Usually we recommend leaving the ovaries unless the hysterectomy is being done for cancer. The different kinds of hysterectomies are:

• Vaginal
• Total abdominal
• Total laparoscopic

For most people with a small uterus, the laparoscopic hysterectomy is less invasive and results in less postoperative pain and a shorter down time. While the down time after an abdominal hysterectomy is six weeks, patients can go home one day after a laparoscopic hysterectomy. Anatomic factors or concurrent pelvic prolapse may alter the surgery recommendation for some patients.