In the preceding post we started by giving the medical definition of heavy periods and went on to discuss possible causes. In this post we shall be discussing making a diagnosis of menorrhagia, testing and treatment options.
To be certain of a diagnosis of menorrhagia, the doctor has to rule out other menstrual disorders, medical conditions or medications as possible causes or aggravations of this condition.
For starters a detailed medical history must be obtained from the patient and a full physical examination performed.
Laboratory studies that may be useful include the following:
- Complete blood count
- Iron studies (total iron-binding capacity [TIBC] and total iron)
- Coagulation factor studies
- Human chorionic gonadotropin (hCG) level
- Thyroid function tests and prolactin level
- Liver function tests (LFTs), renal function tests (blood urea nitrogen [BUN] and creatinine), or both
- Hormone assays (eg, luteinizing hormone [LH], follicle-stimulating hormone [FSH], and androgen) for suspected PCOS; adrenal function tests for suspected adrenal tumors.
Imaging studies and other diagnostic measures which may be done in addition include:
- Pelvic ultrasonography – This imaging method uses sound waves to produce images of your uterus, ovaries and pelvis.
- Sonohysterography (saline-infusion sonography) – During this test, a fluid is injected through a tube into the uterus by way of your vagina and cervix. The doctor then uses ultrasound to look for problems in the lining of the uterus.
- Papanicolaou (Pap) smear – In this test, cells from the cervix are collected and tested for infection, inflammation or changes that may be cancerous or may lead to cancer.
- Hysteroscopy – This exam involves inserting a tiny camera through the vagina and cervix into the uterus, which allows the doctor to see the inside of the uterus.
- Endometrial biopsy – The doctor may take a sample of tissue from the inside of your uterus to be examined by a pathologist
Treatment can only commence after some of the above tests are completed and a possible cause is at least suspected. Specific treatment for menorrhagia is based on a number of factors, including:
- Patients overall health and medical history
- The cause and severity of the condition
- Your tolerance for specific medications, procedures or therapies
- Future childbearing plans of the patient
- Patients personal preference
Drug therapy for menorrhagia may include:
- Iron supplements. Excessive blood loss may lead to anemia and this can be managed by taking iron supplements regularly.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen help reduce menstrual blood loss. NSAIDs have the added benefit of relieving painful menstrual cramps (dysmenorrhea).
- Tranexamic acid. This drug helps reduce/stop menstrual blood loss and should only be taken at the time of the bleeding.
- Oral contraceptives. These contain hormones that can help regulate menstrual cycles and reduce episodes of excessive or prolonged menstrual bleeding.
- Oral progesterone. This is the most frequently prescribed medication for menorrhagia. When taken for 10 or more days of each menstrual cycle, it can help correct hormone imbalance and reduce menorrhagia.
- The hormonal IUD (Mirena). This intrauterine device releases a type of progestin called levonorgestrel, which makes the uterine lining thin and decreases menstrual blood flow and cramping.
When drug therapy doesn’t work, the next alternative is usually surgical management. Surgical options include:
- Dilation and Curettage (D&C). This is a procedure in which the top layer of the uterus lining is scraped off to reduce menstrual bleeding. This procedure might need to be repeated over time.
- Operative hysteroscopy. A surgical procedure, using a special camera to view the inside of the uterus, and can be used to help remove polyps and fibroids, correct abnormalities of the uterus, and remove the lining of the uterus to manage heavy menstrual flow.
- Endometrial ablation or resection. Two types of surgical procedures using different techniques in which all or part of the lining of the uterus is removed to control menstrual bleeding. While some patients will stop having menstrual periods altogether, others may continue to have periods but the menstrual flow will be lighter than before. Although the uterus is not removed, women who have this procedure will not be able to have children in the future.
- A major operation that involves surgically removing the entire uterus. After having this procedure, a woman can no longer become pregnant and will stop having her period.
Menorrhagia is a somewhat common menstrual disorder, but many women do not know that they can get help for it. Some women do not get help because they are too embarrassed to even talk about it. Talking openly with your doctor is very important in making sure you are diagnosed properly and get the right treatment. So if you even think you may have heavy periods but are not sure, be sure to see a doctor and express your concerns.
