5-Minute Clinical Consult Explore these free sample topics:
-- The first section of this topic is shown below --
- Menorrhagia is an excessive amount or duration of menstrual flow at predictable intervals. Flow ≥80 mL/cycle, compared with normal average of 30–60 mL that lasts for more than 7 days.
- Menorrhagia implies ovulation or regular cyclic menses, not irregular bleeding.
- Distinguishable from, but may overlap with, the following:
- Metrorrhagia: irregular or frequent flow, noncyclic
- Menometrorrhagia: frequent, excessive, irregular flow in amount and duration (menorrhagia plus metrorrhagia)
- Polymenorrhea: frequent flow, cycles of ≤21 days
- Intermenstrual bleeding: bleeding between regular menses
- Abnormal uterine bleeding (AUB): abnormal endometrial bleeding of hormonal and other causes related to pregnancy, anovulation (estrogen breakthrough), estrogen or progesterone excess or withdrawal, thyroid disorders, adenomyosis, endometriosis, malignancy, as well as infection and bleeding disorders
- System affected: reproductive
- The prevalence of menorrhagia is estimated at 30% in the general population during reproductive years and increases with age.
- Menarche to menopause; ∼50% of cases occur in patients age >40 years.
- Menorrhagia is fairly common in adolescence and in the perimenopausal period.
- In adolescence, irregular or heavy bleeding due to anovulation and immaturity of the hypothalamic–pituitary–ovarian axis is common.
- In adolescence, severe menorrhagia may be associated with a bleeding disorder up to 40% of the time, with platelet function defects and von Willebrand disease being the most common.
Genital bleeding before puberty can result from trauma, foreign bodies, vaginal infection due to abuse, or exogenous hormone administration but is not considered menorrhagia by definition.
Bleeding in pregnancy is not menorrhagia. But menorrhagia in a period a couple days late could be a miscarriage.
Etiology and Pathophysiology
- Hypothyroidism if regular menses
- Endometrial proliferation//hyperplasia
- Anovulation; oligo-ovulation frequently associated with heavy, prolonged, painful periods; called menorrhagia if occurring regularly
- Ovarian tumor or other estrogen-producing tumor
- Prolonged use of oral combination pill formulated to allow menses
- Polycystic ovarian syndrome, (PCOS) (although menses often irregular)
- Local factors:
- Abnormal endometrial prostaglandin levels
- Endometrial polyps
- Endometrial neoplasia
- Uterine myomata (fibroids)
- Intrauterine device (IUD)
- Uterine sarcoma
- Coagulation disorders:
- Thrombocytopenia, platelet disorders
- von Willebrand disease, factor deficiencies
- Ingestion of aspirin/acetylsalicylic acid or anticoagulants
- Renal failure/dialysis leading to uremic platelet dysfunction
- Obesity due to estrogen excess
- Anovulation due to chronic unopposed estrogen stimulation (menses usually irregular)
- Family history of endometrial or colon cancer
Combined oral contraceptives help prevent menorrhagia when progesterone is dominant. Lower estrogen doses result in less menstrual bleeding. Ibuprofen inhibits prostaglandin production without permanently affecting platelets and is also noted to decrease blood loss at menses. Progesterone-only contraceptives reduce blood loss but can often convert menorrhagia to unpredictable (although lighter) uterine bleeding.
Commonly Associated Conditions
Endometriosis, adenomyosis, fibroids, low-grade infection