Menorrhagia is defined as excessive uterine bleeding occurring at regular intervals or prolonged uterine bleeding lasting more than seven days. The classic definition of menorrhagia (i.e., greater than 80 mL of blood loss per cycle) is rarely used clinically. Women describe the loss or reduction of daily activities as more important than the actual volume of bleeding.
Signs and symptoms of menorrhagia may include:
Soaking through one or more sanitary pads or tampons every hour for several consecutive hours
Needing to use double sanitary protection to control your menstrual flow
Needing to wake up to change sanitary protection during the night
Bleeding for longer than a week
Passing blood clots larger than a quarter
Restricting daily activities due to heavy menstrual flow
Symptoms of anemia, such as tiredness, fatigue or shortness of breath
Medications such as:
Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen or naproxen sodium, help reduce menstrual blood loss. NSAIDs have the added benefit of relieving painful menstrual cramps (dysmenorrhea).
Tranexamic acid helps reduce menstrual blood loss and only needs to be taken at the time of the bleeding.
Oral contraceptives. Aside from providing birth control, oral contraceptives can help regulate menstrual cycles and reduce episodes of excessive or prolonged menstrual bleeding.
Oral progesterone. The hormone progesterone can help correct hormone imbalance and reduce menorrhagia.
Hormonal IUD. This intrauterine device releases a type of progestin called levonorgestrel, which makes the uterine lining thin and decreases menstrual blood flow and cramping.
Dilation and curettage (D&C). In this procedure, your doctor opens (dilates) your cervix and then scrapes or suctions tissue from the lining of your uterus to reduce menstrual bleeding. Although this procedure is common and often treats acute or active bleeding successfully, you may need additional D&C procedures if menorrhagia recurs.
Uterine artery embolization. For women whose menorrhagia is caused by fibroids, the goal of this procedure is to shrink any fibroids in the uterus by blocking the uterine arteries and cutting off their blood supply.
Focused ultrasound surgery. This procedure uses ultrasound waves to destroy the fibroid tissue
This procedure involves surgical removal of uterine fibroids if they are the ones causing menorrhagia. Myomectomy can be done by using open abdominal surgery, through several small incisions (laparoscopically), or through the vagina and cervix (hysteroscopically).
Endometrial ablation. This procedure involves destroying (ablating) the lining of your uterus (endometrium). The procedure uses a laser, radiofrequency or heat applied to the endometrium to destroy the tissue.
Endometrial resection. This surgical procedure uses an electrosurgical wire loop to remove the lining of the uterus. Both endometrial ablation and endometrial resection benefit women who have very heavy menstrual bleeding. Pregnancy isn’t recommended after this procedure.
Hysterectomy — surgery to remove your uterus and cervix — is a permanent procedure that causes sterility and ends menstrual periods. Hysterectomy is performed under anesthesia and requires hospitalization. Additional removal of the ovaries (bilateral oophorectomy) may cause premature menopause.
An endometrial ablation is a minimally invasive procedure to reduce or totally stop bleeding during menstrual cycles.
Heavy menstrual bleeding can have many causes such as fibroids but endometrial ablation is being used to treat the symptom i.e. heave blood loss but not the fibroids.
Endometrial ablation is being done by accessing the endometrium (which is the lining of the uterus) vaginally and ablating it completely or partially i.e. right endometrium.
BARBARA S. APGAR, MD, MS, AMANDA H. KAUFMAN, MD, UCHE GEORGE-NWOGU, MD, and ANNE KITTENDORF, MD, University of Michigan Medical Center, Ann Arbor, MichiganAm Fam Physician. 2007 Jun 15