Menorrhagia is one of the most common gynaecologic complaint seen in most of women and young girls. Almost every women experiences such episode of bleeding at some point of time in their life.

Menorrhagia may start anytime from menarche through reproductive years to menopause.

WHAT IS MENORRHAGIA?

Menorrhagia is defined as a cyclic bleeding at normal intervals, the bleeding is either excessive in amount or duration or both.

The term menorrhagia is derived from the greek word

MEN meaning Menses
RRHAGIA meaning burst forth.

Menorrhagia interferes with a womens physical, emotional and social quality of life.

LETS US NOW FIRST UNDERSTAND THE NORMAL MENSTRUAL BLEEDING

A normal menstrual blood loss is 50 to 80 ml and usually does not exceed more than 100 ml.
In menorrhagia, the menstrual cycle is unaltered but the duration and quantity of menstrual bleed are increased.
Menorrhagia is essentially a symptom and not a disease in itself.

NORMAL CONTROL OF MENSTRUAL BLEED

Once the menstrual bleeding starts the platelet forms clots in the opened vessels. Prostaglandins causes myometrial contractions and constricts the endometrial vessels. The repair of endothelial regeneration begins on 3rd and 4th day of period, by growth of epithelial cells from the open endometrial glands aided by vasculal endothelial epidermal and fibroblastic growth factor.
In menorrhagia or excessive bleeding with regular menstrual cycles, the Hypothalamopituitary ovarian axis is intact but endometrial changes get altered.

What are Ovulatory and Anovulatory Cycles?

A more logical approach is to divide the abnormal uterine bleeding into those patterns associated with ovulatory and anovulatory cycles.

Ovulatory Cycles

Normal menstrual bleeding with ovulatory cycle ia spontaneous, regular, cyclic, predictable and frequently associated with discomfort that is dysmenorrhoea.

Anovulatory Cycles

Uterine bleeding that is unpredictable with respect to the amount, onset and duration and is usually painless, as in dysfunctional uterine bleeding like menorrhagia.

CAUSES OF MENORRHAGIA

The most common cause lies in Disturbed Hypothalamo-Pitutary-Ovarian axis resulting in condition like polycystic ovaries PCOS, Immature development of organs results in anovulation in the earlier years, unapposed oestrogen causing endometrial hyperplasia. As the girl matures the normal menstrual cycle are established.

General Causes – Blood dyscrasia, coagulation disorders, thrombocytopenic purpura, severe anaemia, leukamia, Von willebrand disease.

Uterine Causes –  Uterine fibroids, fibroidal polyps, adenomyosis, endometrial hyperplasia, endometriosis etc.

Pelvic inflammatory diseases can cause menorrhagia.

Use of Intrauterine devices, it is seen that 5 to 10% of women using intra uterine devices suffer from menorrhagia in 1st few months.

Pregnancy complications include Single, heavy, late period may be due to miscarriage. Another cause of heavy bleeding during pregnancy includes location of placenta , low lying placenta or placenta previa.

Malignancies – Uterine cancer or cervical cancer can cause heavy bleeding.

Medications– Certain medications can cause heavy menstrual bleeding.

Thyroid dysfunctions can also be one of the cause for menorhhagia.

SYMPTOMATIC REPRESENTATION OF MENORRHAGIA

• Heavy vaginal bleeding resulting in saturation of one ore more sanitary pad, requring double protection, and need to sanitary pad more frequently.
• Bleeding along with passage of clots and usually lasts for more than a week affecting the routine of a women.
• Pelvic pain though not present in all cases of menorrhagia is frequently encountered symptom of menorrhagia. This may be seen in menorrhagia due to infections and conditions like endometriosis, adenomyosis and pregnancy related complications.
• If the patient presents with pelvic infections there may be other symptoms like fever, chills, copious vaginal discharge.
• Excessive and prolonged menorrhagia leads to anaemia. Usually the patient manifests in the form of excessive weakness, easy fatigue, pale skin, shortness of breath.
• Menorrhagia caused due to hormonal imbalance in diseases like polycystic ovarian disease, patient may present with hirusitism, acne etc.
• Delayed appearance of menstrual bleeding phase with Heavy bleeding is due to anovulatory dysfunction of ovary with prolonged influence of Oestrogen
• Frequent / Early appearance of menstrual bleeding phase i.e. interval less than 21days with:

1. Normal bleeding – is always an anovulatory cycle.
2. Heavy Bleeding – is due to ovarian dysfunction

DIAGNOSIS

Diagnosis of menorrhagia can be done based on the complete medical history of the patient and conducting a complete physical examination including a pelvic examination.

Other diagnostic procedures for menorrhagia may include

• Routine blood examination
• Pelvic ultra sound scan is the first line of diagnostic tool for identifying structural abnormalities.
• Hysteroscopy, includes visual examination of canal of cervix and interior of uterus using an instrument inserted in the vagina.
• Pap test to rule out neoplasia.

ASSESSMENT OF MENORRHAGIA

• We should note the total duration of bleeding and how much time it is heavy bleed.
• Assess the length and duration of cycle.
• How often or how frequently the patient has to change her sanitary pad.
• Enquire about the passage of clots. Clots represent heavy flow and are painful as they pass through the cervix.
• Look for any symptoms suggestive of anemia like easy fatigue, shortness of breath, weakness etc.
• Enquire whether menorrhagia has an impact on her personal life and is hampering her day to day activities.
• Enquire about any past medical illness including clotting disorders, thyroid dysfunctions or any other gynaecological history.

MANAGEMENT OF MENORRHAGIA

Some useful measures like general measures to improve the health status of patient.

Maintain a menstrual calender noting duration and extent of blood loss.

Adequate rest during menses.

Advise for proper diet with a healthy and balanced diet to regulate the menstrual cycle. Choose a diet that includes fresh fruits, vegetables, whole grains, meat, fish, food ricch in protein vitamins, iron, calcium.

Excercise regularly – Besides emproving blood circulation, excercise also helps to maintain weight. As fat cells release excessive oestrogen from body, excercise helps to maintain an optimum hormone balance.

HOMEOPATHIC MEDICINES COMMONLY USED FOR MENORRHAGIA

1. HAMAMELIS VIRGINIANA

   Very useful homeopathic remedy for passive dark bleeding very useful medicines in inter-menstrual pain and bleeding; Vicarious menstruation dark profuse bleeding with much clots and membranous discharge; passive bleeding; in patients with heamorrhagic cyst ovarian cyst; vulva feels sore with much pruritus and severe pain in lumbar region; good remedy for post partum bleeding.

2. LACHESIS

   Hemorrhagic tendency typically suited during climacteric age when patient has hormonal changes which causes mood swings and other menstrual abnormality especially menorrhagia. This remedy is called in when patient shows peculiar mental symptoms like mentally too restless, jealous, pt is too jealous too harm someone but her benevolent side stops her doing so,  loquacious jumps from one topic to other with no head or tail in talks, abusive ill-humored , too much of suppressed sexual desires causing nymphomania, too suspicious keeps doubting everyone around her that they all are conspiring against her, she develops a religious mania and also feels as if she is under some supernatural powers.

3. HELONIAS DIOICA

   Too frequent and too profuse menses, with swollen sensitive breast and nipples swollen red congested burning with pruritus in vulva and severe pain in back.

4. USTILAGO MAYDIS

   Excessive menses during at climacteric age blood dark with much coagulation forming long black strings and much clotting, uterine bleeding after delivery or miscarriage, uterus much enlarged in size. headaches due to menstrual irregularities.

5. MILLEFOLIUM

   heamorrhagic diathesis; menorrhagia with bright red blood, profuse, prolonged and starts too early. bad effects due to lifting weights or due to pregnancy which causes varicose veins that bleed easily.

6. CARICA PAPAYA

   if given in excess dosing unhomoeopathically, this remedy will promote uterine bleeding and also aborts fetus and if administered homoeopathically in similimum dosing it will stop uterine bleeding

7. JANOSIA ASHOKA

   very good remedy in lower potency and in crude mother tincture form, in women with menorrhagia and infertility due to hormonal ovarian or uterine imbalances. Its a very good tonic for female reproductive system used since ancient times in india in ayurveda now its homoeopathic tincture is showing promising results in homoeopathy as well

8. FRAXINUS AMERICANA

   I have found this medicine wonderfully effective in curing menorrhagia especially due to thickeneng of endometrium in mother tincture form in frequent repetitions. also menorrhagia due to fibroids and polyps prolapse of uterus is well tackled with this medicine not only stopping the bleeding but also regressing its cause.

9. TRILLIUM PENDULUM

   A wonderful remedy for Uterine Heamorrhages uterine bleeding aggravates on slightest movement with bright red blood gushing out accompanied with sensation os if lumbar region and gluteal region was breaking into pieces and wants it to tie it with a bandage. menorrhagia during climecteric age; menorrhagia with prolapse of uterus.

10. GERANIUM METALLICUM

    a very good remedy for non specific bleeding from any organ also has a very good action on uterine bleeding too profuse menorrhagia.