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Menorrhagia or heavy bleeding is a symptom of an underlying disease. Diagnosis and treatment is usually directed at the disease.
Therapy for Menorrhagia include anti-inflammatory drugs, hormone-releasing intrauterine devices and so forth.(1-4)
Women with Menorrhagia especially with cramps benefit from Non-steroidal anti-inflammatory drugs (NSAIDs) or painkillers.
These sometimes reduce the bleeding. These include Mefenamic acid, Naproxen and Ibuprofen.
Most women benefit with Hormone-releasing intrauterine devices (IUDs).
The levonorgestrel intrauterine system (LNG-IUS) is one such device. This device is inserted into the womb and will be kept inside for nearly five years.
The side effects of the LNG-IUS are irregular bleeding for six months or more, breast tenderness, propensity for acne, headaches and no periods at all etc.
LNG-IUS reduces blood loss by 71-96% in most women and is the first choice treatment for women with Menorrhagia.
Some women may need the oral contraceptive pill. These contain both estrogen and progesterone.
The progesterone component especially helps reduce bleeding.
In women with hormonal disorders like Polycystic ovarian disorder or with lack of egg release from the ovary (anovulatory cycles) OCP may be beneficial.
Some women may need only progesterone. Norethistrone may be prescribed to these women.
Common side effects with Progesterone-only-pills include weight gain, weight gain, bloating, tenderness of breasts, headaches and propensity for acne.
Tranexamic acid may be used in women with heavy menstrual bleeding. This allows blood clotting and reduces the tendency to bleed. The effect is temporary and less than hormone-releasing IUD.
Gonadotropin-releasing hormone agonists are used on a short-term basis to reduce blood flow. They inhibit pituitary (a small gland in the brain) release of FSH and LH. This suppresses the ovaries.
Surgery of fibroids (myoma) and polyps of the uterus may be suggested to prevent excessive bleeding. Removal of the myoma is termed myomectomy.
Some women may undergo an operation for removal of the endometrium or the lining of uterus.
This is called endometrial resection. Sometimes the endometrium may be burnt or cauterized using electricity. This is called endometrial ablation. This may be done using laser beams as well.
Sometimes a Roller blade curette may be used to perform ablation. Microwaves, hot fluid filled balloons are other therapy options.
Sometimes a woman may need complete removal of the uterus as a measure to stop uterine bleeding.
Choice of treatments is important. Many patients may also opt for no specific therapy.
Patients are counselled regarding relative effectiveness of treatment, likelihood of side effects, need for contraception, possible effects on fertility etc.
Therapy specifically aims at stopping bleeding, preventing and correcting anemia and improving the day to day quality of life of the women.
In many cases there are no underlying conditions to explain Menorrhagia. Yoga and relaxation techniques may help these women. Regular exercise also helps some women.
Edited by April Cashin-Garbutt, BA Hons (Cantab)