Menometrorrhagia

Menometrorrhagia is a medical condition related to the menses cycle. It’s important to understand normal menstruation first.

Facts about Normal Menstruation

Menstruation is commonly referred to as a monthly period, menstrual period or menstrual bleeding. It’s a normal cycle, occurring monthly, that begins in females at the age of 12-14. A girl’s first period is also called menarche. It is a sign of puberty.

Menstruation is a necessary part of a woman’s bodily functions, since it will prepare her body for pregnancy. When the mature egg isn’t fertilized by a sperm during a menstrual cycle, the lining (endometrium) of the woman’s uterus sloughs off. The content then passes through her cervix and vagina.

Menstrual cycles are regulated by the hormones progesterone and estrogen.

Menstruation lasts for about four days. If a woman bleeds more than seven days, it is called menorrhagia.

The typical interval between one menses and the next is 28 days. Any time from 21 to 35 days is considered to be normal. If an interval lasts less than 21 days or more than 35 days, it is considered abnormal.

The loss of menstrual blood during one menses is about 30 ml. Anything between 10 and 80 ml is still called normal.

36% of menstrual discharge is blood.

70% of the blood loss typically occurs within the first two period days.

About 13 mg of iron is lost in a typical menses cycle.



What is Menometrorrhagia?

Menometrorrhagia occurs when excessive or prolonged uterine bleeding occurs frequently or irregularly. It includes menstrual hemorrhage at times that are not predictable.

Menometrorrhagia Causes

  • Uterine lesions

Uterine cavity lesions like endometrial polyps may cause too much blood flow from the uterus.

  • Anovulation

An anovulatory cycle can cause menometrorrhagia, especially if patients are in their first two years of periods. The thickness of the endometrium is caused by estrogen. In anovulation, there is a problematic lack of progesterone.

When ovulation does not occur, there isn’t any progesterone to start the cycle’s secretory phase. This results in a thicker and unstable endometrium. This causes excessive, prolonged bleeding.

  • Adenomyosis

“Adeno” is the medical term for gland and “myo” is used to refer to muscles. Adenomyosis occurs when the uterine glands are lodged within muscles. This will lead to heavy and painful menstrual bleeding.

  • Disorders in Blood Coagulation

Menometrorrhagia can be caused by disorders in coagulation of blood, like von Willebrand’s disease or a prothrombin deficiency. In these cases, there is insufficient clotting factor within the blood. Fewer clots will form, and prolonged bleeding occurs.

If the patient has a family or personal history of menstrual hemorrhage or bleeding tendencies, her physician will check bleeding time, prothrombin time (also called PT) and activated partial thromboplastin time (APTT).

In a research study conducted by Cowell and Claessens, about 20% of adolescent female patients suffered from uterine bleeding that was considered abnormal.

  • Hypothyroidism

Greisman and Wilansky conducted a research study on 67 women with severe menorrhagic problems but with normal thyroid levels and functions. 15 showed a positive reaction to a thyrotropin-releasing hormone (also called TRH) stimulation test.

These women received daily doses of 50-200 mg of levothyroxine for three to six months, and this treated their prolonged and heavy bleeding.

  • Endometrial Adenocarcinoma

Perimenopausal (just beginning menopause) women with prolonged, intermenstrual bleeding may have carcinoma. This is believed to result from the unstable hormones that are caused by the aging process. These cases often are not noticed by patients.

  • Cirrhosis

Cirrhosis makes the liver unable to efficiently metabolize estrogen, and it can lead to menometrorrhagia.

Diagnosing Menometrorrhagia

The methods below can be used to diagnose menometorrhagia:

  • The PAP smear is the standard procedure used to check microscopically for cancer of the cervix.
  • Endometrial curettage or biopsy where the results may show a fluctuation in estrogen levels
  • A hysteroscopy allows the physician to visualize the patient’s uterus, to see if there are any abnormalities, and to collect samples of tissue. This procedure can also be used as a treatment modality, since correction can be done to gross abnormalities while the procedure is being performed.
  • Endovaginal ultrasound tests allow the physician to visualize any intrauterine lesions.
  • Bleeding time, Prothrombin Time and Activated Partial Thromboplastin Time testing will help in determining whether the menometrorrhagia is caused by blood coagulation disorders.
  • Saline infusion ultrasonography is a less invasive hysteroscopy using 10-15 ml of saline infused, to allow for visual checking of endometrial lesions. Unlike the standard hysteroscopy, however, there is no ability to collect tissue samples or treat a condition during this procedure.

Differential Diagnosis

Menometrorrhagia may be confused with other types of abnormal bleeding from the endometrium. What makes these types different than menometrorrhagia?

Menorrhagia

Menorrhagia is also called hypermenorrhea. It is regular menstruation with heavy or prolonged flow. The blood loss may be 80 ml or more, or the woman may have periods lasting for over eight days.

Metrorrhagia

Metrorrhagia includes irregular menstrual cycles with both heavy and prolonged flow. The blood loss during menses is 80 ml or higher AND the duration of periods is more than eight days.

Natural Treatments

  • Agrimony reduces the menstrual flow and alleviates cramping. It is soothing and aromatic, like herbal teas.
  • Banana flower is helpful in decreasing the flow of menstrual blood by increasing the patient’s level of progesterone. It can be cooked and eaten with a curd.
  • Mango bark can be taken as 10 ml of this extract in 120 ml of distilled water, once an hour.
  • Coriander Seeds are used by boiling 20 grams of the seeds in one cup of water. It should be removed from heat and not used as a drink until only 1/4 of this mixture is still in the cup.
  • Mustard Seeds are utilized by grinding 50 grams of the dried seeds. The patient can dissolve the seeds in goat’s milk and drink it two times a day, before the start of her menstrual cycle.

Medical Management

  • High Dosages of Conjugated Equine Estrogen

Estrogen thickens the endometrium during monthly cycles. Patients without enough estrogen could have irregular periods, since there isn’t enough time for the endometrium to become thick enough to slough off.

Estrogen is helpful in stabilizing bleeding. It also increases the clotting factors V & IX and fibrinogen. This allows the patient’s platelets to aggregate, forming clots, and leading to decreased bleeding.

  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

A uterus that is menometrorrhagic produces prostacyclins in larger than normal amounts. Thromboxanes are blood coagulators and platelet aggregators. Prostacylins inhibit these coagulators in menometrorrhagia.

NSAIDs like diclofenac and naproxen prevent additional prostacyclin formation, which decreases the flow of menstrual blood.

  • Danazol (Danocrine)

Danazol is an androgen that will inhibit follicle-stimulating hormones and luteinizing. The endometrium atrophies, as a result. Danazol will also enhance thrombopoiesis and erythropoiesis.

  • Selective Progesterone Receptor Modulators (SPRM)

Uterine blood vessels are the targets for SPRMs. Studies have shown that they prove effective in the decrease of menstrual-related blood flow, without affecting extracellular matrix composition and angiogenic factors.

  • Blood Transfusions

If a patient suffers from anemia caused by excessive menstrual bleeding, a blood transfusion may be necessitated.

  • Arginine Vasopressin Derivatives

A patient with menometrorrhagia that is brought on by blood coagulation disorders may be treated with this option. It will increase von Willebrand factor and factor VIII.

  • Acetaminophen & Ibuprofen

These medications can be used to manage pain.

  • Folic Acid & Iron Supplements

Usually, 13 mg of iron may be lost each menstrual period. If there is excessive blood loss as in menometrorrhagia, much more iron is lost. Folic acid and iron supplements can correct this anemia.

Surgical Interventions

  • Endometrial Ablation

Ablation removes the lining of the patient’s uterus, the endometrium. This is what sloughs off in menstrual periods. After ablation is done, the bleeding will be reduced.

  • Dilatation and Curettage (D&C)

This treatment treats menometrorrhagia only temporarily, so it isn’t often the best choice for this purpose. It may only be useful for one to two months after the procedure.

  • Hysterectomy

The uterus itself is permanently removed in this procedure. It is the definitive treatment for menometrorrhagia. However, this is not an option if a couple wants to have children together.

Complications of Menometrorrhagia

  • Dysmenorrhea

Menometrorrhagia causes endometrial cramping. NSAIDs may help in pain alleviation.

  • Iron Deficiency Anemia

Due to the higher than normal blood loss in menometrorrhagia, there are lower levels of hemoglobin transporting oxygen to the body’s tissues. This can lead to fatigue, pallor and dizziness.

  • Infertility

The irregular hormone imbalances and menstruation may cause a woman to eventually become infertile.


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