hypermenorrhea

Abundant menstruation

"Hypermenorrhea" is synonymous with copious menstruation, often associated with menorrhagia (menstrual bleeding that exceeds the canonical 7-8 days) and metrorrhagia (unexpected vaginal blood loss during the intermenstrual phase).

The link between hypermenorrhea, menorrhagia and metrorrhagia is very close, so much so that it is often very difficult to distinguish the three phenomena.

In some cases, hypermenorrhea is also associated with situations of polymenorrhea, ie a shortening of the intermenstrual period (menstruation too close to each other).

Menstrual losses

Among the various disorders related to the ovarian cycle, the hypermenorrhea indicates, in most cases, a regular cycle, but remarkably abundant: if on the whole the vaginal blood loss, in physiological conditions, is around 30-35 ml, in the hypermenorrhea the overall menstrual flow can reach up to 80 ml. However, it remains almost complicated to establish precisely the amount of blood lost during menstruation, since it is estimated that about half of the losses are represented by endometrial transudate, extra-hematic fluids and mucus.

Consequences

The immediate consequence that derives from the abundant losses linked to hypermenorrhea can be identified in iron deficiency anemia: iron deficiency in the blood is a condition that afflicts many women who suffer from hypermenorrhea. In this regard, an iron supplement is recommended, subject to medical prescription. In the most serious cases of hypermenorrhea, blood transfusions must be used to rebalance blood loss.

Causes

The strong menstrual hemorrhage, typical of hypermenorrhea, occurs because the uterus is unable to stop the loss of blood: in practice, it fails to hemostatize when the functional layer detaches from the mucosa.

Haemostasis cannot be guaranteed when there is an accumulation of blood at the uterine level (congestion), associated with the physiological blood loss of the menstrual cycle: if these factors are added to the inability of a correct contraction by the endometrium and coagulation diseases, the haemorrhagic picture is further amplified.

Hypermenorrhea could be a sign of adenomas, myomas, uterine polyps and general genital pathologies, but it could also indicate more serious diseases, such as nephropathy, leukemia, hypertension (systemic diseases).

Endometritis, ie acute inflammation of the endometrium, can cause blood accumulations; at the time of menstruation, congestions can create hypermenorrhea.

Among the other causal factors that contribute to the manifestation of hypermenorrhea, we remind the introduction of foreign bodies in the vagina: for example, intrauterine contraceptive devices could irritate the mucosa and cause hypermenorrhea; even contraceptive pills, especially low-dose ones, could cause unpleasant hypermenorrhea phenomena due to a possible "refusal" by the uterus to "accept" hormonal modulation. In general, women who take the low-dose contraceptive pill and suffer from hypermenorrhea are not constitutionally suitable to support a progestin therapy of this type: the uterus, in fact, interprets the low dose of the pill as the opportune moment to favor menstruation. In this case, the gynecologist may propose an alternative pill to the patient.

Furthermore, some antipsychotic and antidepressant drugs may also burden the uterus and promote episodes of hypermenorrhea.

Another factor that affects the appearance of hypermenorrhea is the variation in estrogen production: from a clinical-diagnostic point of view, an over-production of estrogens leads to a change in the morphology of the uterine structures. In fact, the glands increase in volume, the uterine mucosa thickens and the proliferative phase is strengthened and prolonged: in this way the hypermenorrhea is favored.

In the opposite case, that is to say in the absence of estrogens, hypermenorrhea occurs through another mechanism: uterine haemostasis is no longer guaranteed due to the poor development of the musculature of the uterus.

Obviously, also the general fatigue of the woman, stress, work, and environmental variations could, in some way, facilitate the onset of hypermenorrhea: in these cases it is a transient and absolutely harmless phenomenon, but the opinion of the gynecologist is always recommended.

Diagnosis and treatment

Before proceeding with any therapy, the main causes that trigger the hypermenorrhea must be discovered: only in this way, the doctor will be able to prescribe to the patient the most appropriate care to solve the problem. The treatment must, therefore, be aimed at resolving the root cause, which the gynecologist is able to diagnose only after a thorough examination, a biopsy, a reading of the blood values ​​and, possibly, a curettage (test in the uterine cavity).

In general, appropriate drugs are prescribed, such as coagulants and medicines that enhance the tone of the uterine or hormonal based muscles.

Summary

To fix the concepts ...