Heavy or Extended Periods (Menorrhagia)

What is menorrhagia?

Menorrhagia is a fairly common disorder that is characterized by an unusually heavy or long period of menstrual flow. If you have heavier or longer menses for 2 months in a row or more, you should call the office for an appointment.

How does it occur?

This occurs when the lining of the uterus (Endometrium) becomes thick and when shedding occurs, it causes heavy periods. There are many possible causes of menorrhagia, including:

• hormone imbalance, the most common cause (the imbalance is sometimes caused by improper use of hormone medicine) suchas having estrogen without progesterone.
• young women who have not established a regular ovulation cycle.
• women approaching menopause.
• polyps, which are growths on the cervix (the opening of the uterus) or inside the uterus; polyps are usually noncancerous
• fibroids, which are noncancerous growths in the uterus
• endometriosis (uterine tissue growing outside the uterus)
• a cyst (a sac full of fluid or blood) on the ovary
• use of an IUD (intrauterine device) or birth control pills
• pregnancy complications, including miscarriage, threat of miscarriage, and ectopic (tubal) pregnancy
• cancer of the uterus or ovary and sometimes cancer of the cervix
• chronic medical problems (for example, thyroid problems, diabetes, and blood-clotting problems)
• some medicines that thin your blood and cause it not to clot properly.
• pelvic infections

How is it diagnosed?

Your medical history and menstrual cycle information is very helpful in diagnosing the cause of your heavy menses. You will have a pelvic exam even if you are bleeding. Some tests that may be done are urine pregnancy test, CBC (complete blood count), cultures for vaginal infections, urinalysis and urine culture.

Other procedures that you may need are:

• Endometrial biopsy: Dr. Hardy or the Nurse Practitioner will take a sample of tissue from the inside of the uterus. The tissue is sent to the lab for evaluation.
• Ultrasound scan: Sound waves are used to get pictures of the uterus, ovaries, and pelvis. The ultrasound probe may be placed on your lower abdomen or into your vagina.
• Sonohysterogram: An ultrasound scan is done after fluid is injected through a tube into your uterus. This test allows your provider to look for problems with the lining of the uterus, such as fibroids.
• Hysteroscopy: Dr. Hardy will insert a thin metal tube with a light and tiny camera through the vagina and cervix and into the uterus. This allows him to see the inside of the uterus. This procedure is done at the outpatient surgery center.
• Laparoscopy: Dr. Hardy inserts a thin metal tube with a light and tiny camera into your abdomen and pelvis through a small cut in or just below your bellybutton. He uses the scope to look at your uterus and other pelvic organs. This is done in the outpatient surgery center.
• D&C (dilation and curettage): Dr. Hardy will open up the cervix and scrapes or suctions tissue from the lining of the uterus. The tissue is examined in the lab. This procedure is done in the outpatient surgery center.
• Hysterosalpingography: Dye is injected into the uterus and fallopian tubes through the cervix. X-rays are then taken. The dye outlines the shape and size of the uterus and tubes. This is done in the radiology department of the hospital.

How is it treated?

The treatment usually depends on the age of the woman, whether or not she still wants to have more children, and on the cause of the problem. The first step in treatment is usually hormone therapy, either with birth control pills, IUD or progesterone pills taking either daily or the first 12 days of each month.

Sometimes surgery is needed. Possible surgical treatments include:

• D&C, in which tissue is scraped or suctioned from the uterus
• hysteroscopy (to remove a polyp, for example)
• hysterectomy, which is removal of the uterus.

A hysterectomy will cause you to be sterile, that is, unable to become pregnant. If you have a hysterectomy, you will stop having menstrual periods.

An alternative to surgery is having cryoablation in the office. During this procedure, Dr. Hardy will dilate the cervix just a little, look into the uterus with a small thin metal rod that has a magnifying glass on the end, take a small sample of the lining and then proceed with the cryoablation. During this procedure, the cryo probe creates an ice ball inside of the uterus that will destroy the lining. It takes about 6 to 7 minutes on the left and ride side of the uterus. After the procedure, you can expect some mild cramping and watery vaginal discharge for 3 weeks. You will not be able to have sexual intercourse or use tampons or douche for 3 weeks. It may take up to 3 months to see the full effects of the procedure. 80% of women have lighter menses while 20% of those women experience no menstrual periods at all. You will be able to go back to work in 1-2 days after the procedure.

How long will the effects last?

How long you have heavy or extended menstrual bleeding depends on the cause and treatment.