Abundant menstruation
"Menorrhagia" is a medical term that indicates a particularly abundant and abnormal menstrual blood loss; the bleeding can also extend beyond the physiological term of the menstrual period, which in the presence of menorrhagia - in addition to being more intense - is often even more painful.
Menorrhagia should not be confused with metrorrhagia: both conditions include hypermenorrhea, therefore abundant blood loss, but, while menorrhagia coincides with menstrual flow, metrorrhagia occurs between menstruation and the other. A woman could still be affected by both conditions, namely by menometrorrhagia, and in this case the disorder requires more than ever a prompt gynecological diagnosis.
Causes
Menorrhagia can be caused by several factors: hormonal alterations, blood coagulation disorders, pathologies of the female genital tract, introduction of foreign bodies into the vagina, infections and pelvic congestion (caused, for example, by constipation).
Some of these factors related to menorrhagia deserve further investigation.
First, the alteration of hormonal balance can create disturbances that reflect on the menstrual cycle: in general, hormonal changes are caused by malfunctions of the ovary, with variations in the physiological cyclical growth process and involution of the mucosa during period. The ovary, producing an overabundant amount of estrogenic hormones, could cause menorrhagia: the cause of the estrogenic alteration can be primitive or secondary, as a consequence of an excessive stimulation by the pituitary gland. Not surprisingly, the clinical examinations of women suffering from menorrhagia often show a high amount of estrogenic hormones in the blood and urine; however, progesterone deficiency has been detected. In other women, the hormonal alteration is inverse, ie there is no overproduction of hormones, but rather a lack of them. In the first case, the excess of estrogen involves not only menorrhagia, but also an increase in the volume of the breast and external genitals; in the second condition, the hormonal deficiency causes a reduction in the volume of the breasts, uterus and small lips of the vagina.
Menorrhagia is enhanced if, to these factors, capillary fragility and alterations of the thyroid and adrenal glands are also added.
The mechanism that coordinates menorrhagia remains a condition that is not entirely clear.
Menorrhagia in the neonatal age
Even the newborns may show vaginal discharge, which cannot be associated, however, with menorrhagia: probably, the cause of the losses lies, once again, in the hormonal alteration. The mother's estrogenic modulations can affect the daughter, causing tissue reactivity that is reflected with blood loss in the newborn. The event, however, is not pathological.
Menorrhagia in puberty
Menorrhagia occurs often even during puberty, since the endocrine axis of the new woman has yet to be regularized: in the first menstruation, more than a real "menorrhagia" we speak of puberal hemorrhagic metropathy.
Even the introduction, voluntary or otherwise, of foreign bodies in the vagina can cause internal injuries of varying degrees, accompanied by loss of blood which can sometimes coincide with the menstrual cycle. However, this facilitates bacterial infection, which spreads vaginally, causing pain, discomfort, irritation, redness and bleeding.
Even some diseases that affect the female genital tract can cause menorrhagia: uterine fibroids, endometriosis, ovarian tumors, polyps. In this case, menorrhagia is the first indicator light ignited by the body to make it clear that the physiological mechanisms have jammed.
Diagnosis
In the presence of menorrhagia the specialist examination is absolutely fundamental, even from the first symptoms, not only to resolve the abundant menstruation, but also to ascertain the absence of possible pelvic pathologies. Diagnosis is important to establish the causes that cause the disorder: in general, endometrial biopsy is used in case the gynecologist finds dubious problems.
Therapy
The therapy must be aimed at blocking the bleeding: considering that the main causes that trigger metrorrhagia refer to hormonal modulation, the administration of progestins could be a good solution. If, on the other hand, the metrorrhagia is the consequence of a pathology affecting the ovary, the disease must be remedied, first of all, the resolution of which will consequently determine the healing of the menorrhagia itself.
Summary
To fix the concepts
Disorder | Menorrhagia |
Description | Particularly abundant and abnormal bleeding during menstruation (80ml of blood) |
Consequences | Pain, anemia |
Difference with metrorrhagia | Metrorrhagia is a hemorrhage that occurs between one menstruation and another Menorrhagia is a hypermenorrhea during menstrual flow |
Causes | Hormonal alterations, blood coagulation disorders, female genital tract diseases, introduction of foreign bodies into the vagina, infections, pelvic congestion (caused, for example, by constipation) |
Diagnosis | Gynecological specialist visit with eventual biopsy of the endometrium |
Therapy | Hormonal modulation Resolution of the triggering causes (eg pathologies): it follows the healing of the metrorrhagia |
