Menometrorrhagia Definition
Menometrorrhagia is a combination of menorrhagia (excessive menstrual bleeding in amount and duration) and metrorrhagia (irregular, excessive bleeding between periods), resulting in both heavy and irregular uterine bleeding. 1
Clinical Characteristics
Menorrhagia component:
- Objectively defined as menstrual blood loss ≥80 mL per cycle 2
- Heavy cyclical bleeding occurring over several consecutive cycles 2
- Approximately 30% of women report heavy menstrual bleeding at some point in their lives 3, 2
Metrorrhagia component:
- Irregular bleeding patterns that do not follow normal menstrual timing 1
- Excessive flow and duration outside of regular menstrual periods 1
Etiologic Categories
The PALM-COEIN classification system organizes causes into structural and non-structural categories: 4
Structural causes (PALM):
- Polyp - particularly common in women over 40 years 4, 3
- Adenomyosis - frequent in premenopausal women 4
- Leiomyoma (fibroids) - most common structural cause in women under 40 years 4, 3
- Malignancy and hyperplasia - most serious etiology, especially in postmenopausal women 4
Non-structural causes (COEIN):
- Coagulopathy 4
- Ovulatory dysfunction 4
- Endometrial disorders (molecular deficiencies in endometrial hemostasis regulation) 4
- Iatrogenic (exogenous hormones, IUDs, anticoagulation - approximately 70% of women on anticoagulation experience heavy bleeding) 4
- Not yet classified 4
Clinical Significance
Impact on health:
- Rarely life-threatening but significantly impacts quality of life 5
- Can lead to iron deficiency anemia 3
- Accounts for approximately 5% of annual consultations among reproductive-age women in western countries 3
- Responsible for two-thirds of all hysterectomies 2
Critical assessment point: Bleeding that saturates a large pad or tampon hourly for at least 4 hours requires urgent evaluation for hemodynamic instability 4, 6