Menorrhagia is a condition which causes heavy menstruation or menstrual bleeding each month. It is in fact, a symptom of heavy menstruation and not a condition.
It is a symptom of an underlying problem but not the problem itself. There can be many different causes of excessive bleeding in women. A gynecologist, a physician who specializes in the reproductive health of women, should be the one to diagnose the underlying root cause. (1)
Only through correct diagnosis of the underlying reason can a specific treatment protocol be successfully recommended. Diagnosis of irregular menstruation or menorrhagia relies on several different methods. Initially, the physician will take a comprehensive history of the woman. The history will include questions about the age she started her menstrual period, how long periods usually lasts in days, how many days there are between periods, any recent changes in her normal monthly cycle, if she is currently sexually active, the date of her last health exam, if she is currently pregnant or was recently pregnant and if she is on birth control pills and what kind.
After a very thorough medical history the physician will also conduct a physical examination. The basis of this examination is often a pelvic exam looking for underlying reasons such as fibroid tumors to explain heavy bleeding. (2)
The physician may ask the patient to keep a calendar of her bleeding history, keep track of any pain during the month, length of periods, bleeding between periods, and how many days are between periods. Women are also an asked to rate the amount of flow on the days of her period. (3)
Diagnostic tests will also include ultrasounds that can be done in the office to visualize fibroids or uterine wall changes. The doctor may also inject fluid into the uterus and performing ultrasound procedure called sonohysterogram. This test helps to evaluate the health of uterine walls and increase the visibility of any structural abnormalities.
Some common causes for heavy menstrual flow include uterine fibroids, endometrial hyperplasia, hormonal imbalances and polyp growths on the wall of the uterus. Non-typical causes include von Willebrand disease which is an inherited regulation disorder, pelvic inflammatory disease, liver cirrhosis, lupus, intrauterine device, birth control and diabetes.
Another nontypical cause of heavy menstrual flow is a vitamin K deficiency. Vitamin K plays an important role in several different metabolic functions in the body, not the least of which are bleeding disorders. A deficiency in vitamin K will cause a bleeding disorder that has been associated with abnormal uterine bleeding.
Several reasons an individual may be deficient in vitamin K includes using anticoagulants for another underlying medical condition, the use of salicylates, long-term antibiotic use, a metabolic disease or large intake of vitamin K antagonists such as vitamin E or vitamin A. One of the symptoms of hypothyroidism is heavy menstrual flow. Women who have hypothyroidism and are properly treated lose the problem of heavy bleeding.
Treatment for irregular menses is based upon the cause. This is why it is incredibly important for a woman to receive a proper diagnosis prior to treatment. After a thorough exam, history and testing the gynecologist can give a woman an accurate diagnosis and treatment plan based upon current medical practice. However, medicine is an art form and not a science. For this reason it may require patience on the part of the woman before an accurate diagnosis is found. The goal of treatment is to decrease the heavy menstrual flow and improve the patient\’s comfort level.
(1) US National Library of Medicine: Vaginal Bleeding
(2) WomensHealth.gov: Uterine Fibroids Fact Sheet
http://www.menopause.org/ Menstrual Calenda