What is menorrhagia (abnormally heavy or prolonged menstrual bleeding)?

From the Guidelines

Menorrhagia is abnormally heavy or prolonged menstrual bleeding, characterized by bleeding that lasts more than 7 days, requires changing sanitary products every 1-2 hours, passing large blood clots, or losing more than 80ml of blood during a period. This condition can lead to anemia, fatigue, and significant disruption to daily activities. According to the American College of Obstetricians and Gynecologists (ACOG) guidelines, as reported in the American Family Physician journal 1, the PALM-COEIN classification system is used to describe uterine bleeding abnormalities in women of reproductive age, including structural causes such as polyp, adenomyosis, leiomyoma, and malignancy and hyperplasia, as well as nonstructural causes like coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified.

Key Characteristics of Menorrhagia

• Bleeding that lasts more than 7 days
• Requires changing sanitary products every 1-2 hours
• Passing large blood clots
• Losing more than 80ml of blood during a period Treatment options depend on the underlying cause and may include hormonal medications, such as progestin-only contraception and combined hormonal contraception, as suggested by the ACOG guidelines 1.

Treatment Options

• Medical treatments: progestin-only contraception and combined hormonal contraception
• Surgical options: endometrial ablation and hysterectomy, which may be considered if medical treatment fails, is contraindicated, or is not tolerated, or if the patient has concomitant significant intracavitary lesions 1. Menorrhagia can result from hormonal imbalances, uterine fibroids, polyps, adenomyosis, or bleeding disorders. Women experiencing these symptoms should consult a healthcare provider for proper diagnosis, as heavy bleeding can sometimes indicate more serious conditions that require specific treatment.

From the Research

Definition of Menorrhagia

• Menorrhagia is defined as menstrual periods lasting more than 7 days and/or involving blood loss greater than 80ml 2
• Normal menstrual periods last 3-6 days and involve blood loss of up to 80ml 2

Prevalence of Menorrhagia

• The prevalence of abnormal uterine bleeding (AUB) is estimated at 11-13% in the general population and increases with age, reaching 24% in those aged 36-40 years 2

Diagnosis of Menorrhagia

• A blood count for red cells+platelets to test for anemia is recommended on a first-line basis for women consulting for AUB whose history and/or bleeding score justify it 2
• A pregnancy test by an hCG assay should be ordered 2
• A speculum examination and Pap smear should be performed early on to rule out any cervical disease 2
• Pelvic ultrasound, both abdominal (suprapubic) and transvaginal, is recommended as a first-line procedure for the etiological diagnosis of AUB 2

Treatment of Menorrhagia

• The first line of treatment recommended for women with idiopathic menorrhagia is pharmaceutical agents, i.e. levonorgestrel intra-uterine device, tranexamic acid, estroprogestatif pills, oral progestin and non-sterodial anti-inflammatory drugs 3
• Tranexamic acid has proven to be an effective treatment for heavy menstrual bleeding (HMB), reducing menstrual blood loss (MBL) by 26%-60% 4
• The levonorgestrel-releasing intrauterine system (levonorgestrel-IUS) is more effective than usual medical treatment in reducing the effect of heavy menstrual bleeding on quality of life 5