Menorrhagia
Encyclopedia
Menorrhagia is an abnormally heavy and prolonged menstrual period
at regular intervals. Causes may be due to abnormal blood clotting, disruption of normal hormonal regulation of periods or disorders of the endometrial
lining of the uterus
. Depending upon the cause, it may be associated with abnormally painful periods (dysmenorrhea
).
, which occurs at irregular and more frequent intervals. It is possible to estimate the amount of bleeding by the number of tampons or pads a woman uses during her period. As a guide a regular tampon fully soaked will hold about 5ml of blood. One may also have lighter cycles in volume, but blood flow may continue more than seven days thus constituting menorrhagia. An OB/GYN should still be consulted.
process must occur to limit and eventually stop the blood flow. Blood disorders of platelets (such as ITP
) or coagulation
(such as von Willebrand disease
) or use of anticoagulant
medication (such as warfarin
) are therefore possible causes, although a rare minority of cases. Platelet function studies pfa col/epi can also be used to ascertain platelet function abnormalities
) and just before menopause
may in some women be particularly heavy. Hormonal disorders involving the ovaries-pituitary-hypothalamus (the 'ovarian endocrine axis') account for many cases, and hormonal-based treatments may regulate effectively.
The lining of the uterus builds up naturally under the hormonal effects of pregnancy, and an early spontaneous miscarriage
may be mistaken for a heavier than normal period.
As women age and move towards menopause, ovulation is delayed and the remaining follicles in the ovaries become resistant to GnRH ( Gonadotropin releasing hormone )secreted by the hypothalamus
gland in the brain. Either that or they don't develop an egg, and thus no progesterone is produced. Without progesterone, the estrogen is "unopposed" and keeps building up the lining of the uterus.
During a woman's period, the endometrial lining which is normally shed never gets the signal to stop thickening. It keeps growing and sheds irregularly. Due to the extra thickness, the bleeding is unusually heavy. Less frequently in this age group, too little estrogen causes the irregular bleeding. Most cases of hemorrhagic are due to normal hormonal changes preceding menopause.
Irritation of the endometrium may result in increased blood flow, e.g. from infection (acute or chronic pelvic inflammatory disease
) or the contraceptive intrauterine device
(note the distinction from the IntraUterine System
which is used to treat this condition).
Fibroids
in the wall of the womb sometimes can cause increase menstrual loss if they protrude into the central cavity and so thereby increase endometrium's surface area.
Abnormalities of the endometrium such as adenomyosis
(so called "internal endometriosis") where there is extension into the wall of the womb gives rise to enlarged tender uterus. Note, true endometriosis
is a cause of pain (dysmenorrhoea) but usually not alteration in menstrual blood loss.
Endometrial carcinoma (cancer of the uterine lining) usually causes irregular bleeding, rather than the cyclical pattern of menorrhagia. Bleeding in between periods (intermenstrual bleeding or IMB) or after the menopause (post-menopausal bleeding or PMB) should always be considered suspicious.
and menopause
may settle spontaneously (the menarche being the start and menopause being the cessation of periods).
If the degree of bleeding is mild, all that may be sought by the woman is the reassurance that there is no sinister underlying cause. If anemia occurs then iron
tablets may be used to help restore normal hemoglobin
levels.
The condition is often treated with hormones, particularly as dysfunctional uterine bleeding commonly occurs in the early and late menstrual years when contraception is also sought. Usually, oral combined contraceptive
or progesterone only
pills may be taken for a few months, but for longer-term treatment the alternatives of injected Depo Provera
or the more recent progesterone
releasing IntraUterine System
(IUS) may be used. Fibroids may respond to hormonal treatment, and if they do not, then surgical removal may be required.
Tranexamic acid
tablets that may reduce loss by up to 50%. BMJ. 1996 Sep 7;313(7057):579-82.
Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid, and tranexamic acid.
Bonnar J, Sheppard BL.
SourceTrinity College, Department of Obstetrics and Gynaecology, St. James Hospital, Dublin, Ireland.
This may be combined with hormonal medication previously mentioned. Anti-inflammatory
medication like NSAIDs may also been used, but typically cause only a 30% reduction in flow.
A definitive treatment for menorrhagia is to perform hysterectomy
(removal of the uterus). The risks of the procedure have been reduced with measures to reduce the risk of deep vein thrombosis
after surgery, and the switch from the front abdominal to vaginal approach greatly minimizing the discomfort and recuperation time for the patient; however extensive fibroids may make the womb too large for removal by the vaginal approach. Small fibroids may be dealt with by local removal (myomectomy
). A further surgical technique is endometrial ablation
(destruction) by the use of applied heat (thermoablation).
In the UK
the use of hysterectomy for menorrhagia has been almost halved between 1989 and 2003. This has a number of causes: better medical management, endometrial ablation and particularly the introduction of IUS which may be inserted in the community and avoid the need for specialist referral; in one study up to 64% of women cancelled surgery.
:
. Symptoms attributable to the anemia may include shortness of breath, tiredness, weakness, tingling and numbness in fingers and toes, headaches, depression, becoming cold more easily, and poor concentration.
Menstruation
Menstruation is the shedding of the uterine lining . It occurs on a regular basis in sexually reproductive-age females of certain mammal species. This article focuses on human menstruation.-Overview:...
at regular intervals. Causes may be due to abnormal blood clotting, disruption of normal hormonal regulation of periods or disorders of the endometrial
Endometrium
-Function:The endometrium is the innermost glandular layer and functions as a lining for the uterus, preventing adhesions between the opposed walls of the myometrium, thereby maintaining the patency of the uterine cavity. During the menstrual cycle or estrous cycle, the endometrium grows to a...
lining of the uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
. Depending upon the cause, it may be associated with abnormally painful periods (dysmenorrhea
Dysmenorrhea
Dysmenorrhea is a gynecological medical condition of pain during menstruation that interferes with daily activities, as defined by ACOG and others. Still, dysmenorrhea is often defined simply as menstrual pain, or at least menstrual pain that is excessive...
).
Definition
A normal menstrual cycle is 25–35 days in duration, with bleeding lasting an average of 5 days and total blood flow between 25 and 80 mL. A blood loss of greater than 80 ml or lasting longer than 7 days constitutes menorrhagia (also called hypermenorrhea). Some authors use menorrhagia exclusively when describing excessive quantity and hypermenorrhea for prolonged duration (although most use both terms interchangeably in the clinical setting). In practice this is not usually directly measured by patients or doctors. Menorrhagia also occurs at predictable and normal (usually about 28 days) intervals, distinguishing it from menometrorrhagiaMenometrorrhagia
Menometrorrhagia is a condition in which prolonged or excessive uterine bleeding occurs irregularly and more frequently than normal.-Causes:It can occur due to any of several causes, including hormonal imbalance, endometriosis, uterine fibroids, or cancer. It can lead to anemia in long-standing...
, which occurs at irregular and more frequent intervals. It is possible to estimate the amount of bleeding by the number of tampons or pads a woman uses during her period. As a guide a regular tampon fully soaked will hold about 5ml of blood. One may also have lighter cycles in volume, but blood flow may continue more than seven days thus constituting menorrhagia. An OB/GYN should still be consulted.
Cause
Usually no causative abnormality can be identified and treatment is directed at the symptom, rather than a specific mechanism. A brief overview of causes is given below, followed by a more formal medical list based on the nature of the menstrual cycle experienced.Disorders of coagulation
With the shedding of an endometrial lining's blood vessels, normal coagulationCoagulation
Coagulation is a complex process by which blood forms clots. It is an important part of hemostasis, the cessation of blood loss from a damaged vessel, wherein a damaged blood vessel wall is covered by a platelet and fibrin-containing clot to stop bleeding and begin repair of the damaged vessel...
process must occur to limit and eventually stop the blood flow. Blood disorders of platelets (such as ITP
Idiopathic thrombocytopenic purpura
Idiopathic thrombocytopenic purpura is the condition of having an abnormally low platelet count of no known cause . As most incidents of ITP appear to be related to the production of antibodies against platelets, immune thrombocytopenic purpura or immune thrombocytopenia are terms also used to...
) or coagulation
Coagulation
Coagulation is a complex process by which blood forms clots. It is an important part of hemostasis, the cessation of blood loss from a damaged vessel, wherein a damaged blood vessel wall is covered by a platelet and fibrin-containing clot to stop bleeding and begin repair of the damaged vessel...
(such as von Willebrand disease
Von Willebrand disease
von Willebrand disease is the most common hereditary coagulation abnormality described in humans, although it can also be acquired as a result of other medical conditions. It arises from a qualitative or quantitative deficiency of von Willebrand factor , a multimeric protein that is required for...
) or use of anticoagulant
Anticoagulant
An anticoagulant is a substance that prevents coagulation of blood. A group of pharmaceuticals called anticoagulants can be used in vivo as a medication for thrombotic disorders. Some anticoagulants are used in medical equipment, such as test tubes, blood transfusion bags, and renal dialysis...
medication (such as warfarin
Warfarin
Warfarin is an anticoagulant. It is most likely to be the drug popularly referred to as a "blood thinner," yet this is a misnomer, since it does not affect the thickness or viscosity of blood...
) are therefore possible causes, although a rare minority of cases. Platelet function studies pfa col/epi can also be used to ascertain platelet function abnormalities
Excessive build up in endometrial lining
Periods soon after the onset of menstruation in girls (the menarcheMenarche
Menarche is the first menstrual cycle, or first menstrual bleeding, in female human beings. From both social and medical perspectives it is often considered the central event of female puberty, as it signals the possibility of fertility....
) and just before menopause
Menopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...
may in some women be particularly heavy. Hormonal disorders involving the ovaries-pituitary-hypothalamus (the 'ovarian endocrine axis') account for many cases, and hormonal-based treatments may regulate effectively.
The lining of the uterus builds up naturally under the hormonal effects of pregnancy, and an early spontaneous miscarriage
Miscarriage
Miscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation...
may be mistaken for a heavier than normal period.
As women age and move towards menopause, ovulation is delayed and the remaining follicles in the ovaries become resistant to GnRH ( Gonadotropin releasing hormone )secreted by the hypothalamus
Hypothalamus
The Hypothalamus is a portion of the brain that contains a number of small nuclei with a variety of functions...
gland in the brain. Either that or they don't develop an egg, and thus no progesterone is produced. Without progesterone, the estrogen is "unopposed" and keeps building up the lining of the uterus.
During a woman's period, the endometrial lining which is normally shed never gets the signal to stop thickening. It keeps growing and sheds irregularly. Due to the extra thickness, the bleeding is unusually heavy. Less frequently in this age group, too little estrogen causes the irregular bleeding. Most cases of hemorrhagic are due to normal hormonal changes preceding menopause.
Irritation of the endometrium may result in increased blood flow, e.g. from infection (acute or chronic pelvic inflammatory disease
Pelvic inflammatory disease
Pelvic inflammatory disease is a generic term for inflammation of the uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to infections. PID is a vague term and can refer to viral, fungal, parasitic, though most...
) or the contraceptive intrauterine device
Intrauterine device
A copper IUD is a type of intrauterine device. Most IUDs have a plastic T- or U-shaped frame which is wrapped in copper wire, with the exception of Gynefix, which is a plastic string with several copper beads, affixed to the fundus of the uterus...
(note the distinction from the IntraUterine System
IntraUterine System
The IUD with progestogen, intrauterine system , or IntraUterine Contraceptive is a long-acting reversible hormonal contraceptive device that is placed in the uterus. An IUS has a hormone cylinder that releases a progestin called levonorgestrel...
which is used to treat this condition).
Fibroids
Uterine fibroids
A uterine fibroid is a benign tumor that originates from the smooth muscle layer and the accompanying connective tissue of the uterus.Fibroids are the most common benign tumors in...
in the wall of the womb sometimes can cause increase menstrual loss if they protrude into the central cavity and so thereby increase endometrium's surface area.
Abnormalities of the endometrium such as adenomyosis
Adenomyosis
Adenomyosis is a medical condition characterized by the presence of ectopic glandular tissue found in muscle. The term adenomyosis is derived from the terms adeno- , myo- , and -osis...
(so called "internal endometriosis") where there is extension into the wall of the womb gives rise to enlarged tender uterus. Note, true endometriosis
Endometriosis
Endometriosis is a gynecological medical condition in which cells from the lining of the uterus appear and flourish outside the uterine cavity, most commonly on the ovaries. The uterine cavity is lined by endometrial cells, which are under the influence of female hormones...
is a cause of pain (dysmenorrhoea) but usually not alteration in menstrual blood loss.
Endometrial carcinoma (cancer of the uterine lining) usually causes irregular bleeding, rather than the cyclical pattern of menorrhagia. Bleeding in between periods (intermenstrual bleeding or IMB) or after the menopause (post-menopausal bleeding or PMB) should always be considered suspicious.
Consideration by nature of the menstrual cycle
- Excessive menses but normal cycle:
- Painless:
- Fibroids ( leiomyoma )
- Ovarian endocrine disorder (dysfunctional uterine bleedingDysfunctional uterine bleedingDysfunctional Uterine Bleeding is abnormal genital tract bleeding based in the uterus and found in the absence of demonstrable structural or organic pathology.usually due to hormonal disturbances....
or DUB)(the most common cause) - Coagulation defects (rare)
- endometrial carcinoma
- endometrial polyp
- Painful:
- Pelvic inflammatory diseasePelvic inflammatory diseasePelvic inflammatory disease is a generic term for inflammation of the uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to infections. PID is a vague term and can refer to viral, fungal, parasitic, though most...
- EndometriosisEndometriosisEndometriosis is a gynecological medical condition in which cells from the lining of the uterus appear and flourish outside the uterine cavity, most commonly on the ovaries. The uterine cavity is lined by endometrial cells, which are under the influence of female hormones...
- adenomyosis
- Pelvic inflammatory disease
- Painless:
- Short cycle (<21 days) but normal menses (epimenorrhoea or polymenorrhoea). These are always anovulatory cycleAnovulatory cycleThe anovulatory cycle is a menstrual cycle characterized by varying degrees of menstrual intervals and the absence of ovulation and a luteal phase...
s due to hormonal disorders. - Short cycle and excessive menses (epimenorrhagia) due to ovarian dysfunction and may be secondary to blockage of blood vessels by tumours.
- Excessive menses and long intervals.
- Anovular ovarian disorder due to prolonged oestrogen production.
- This may occur following prolonged continuous courses of the combined oral contraceptive pill (e.g. where several packets are taken without a withdrawal gap in order to defer menstruation).
Differential Diagnosis
- Pregnancy complications:
- Ectopic pregnancyEctopic pregnancyAn ectopic pregnancy, or eccysis , is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the parent, since internal haemorrhage is a life threatening complication...
- Incomplete abortion
- MiscarriageMiscarriageMiscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation...
- Threatened abortion
- Ectopic pregnancy
- Nonuterine bleeding:
- Cervical ectropion/erosion
- Cervical neoplasia/polyp
- Cervical or vaginal trauma
- Condylomata
- Atrophic vaginitis
- Foreign bodies
- Pelvic inflammatory disease (PID):
- Endometritis
- Tuberculosis
- HypothyroidismHypothyroidismHypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.Iodine deficiency is the most common cause of hypothyroidism worldwide but it can be caused by other causes such as several conditions of the thyroid gland or, less commonly, the pituitary gland or...
Risk Factors
- Obesity
- Anovulation
- Estrogen administration (without progestogens)
- Prior treatment with progestational agents or oral contraceptives increases the risk of endometrial atrophy, but decreases the risk of endometrial hyperplasia or neoplasia
ICD-9 codes
| Cause | ICD-9 code |
|---|---|
| Polyp of corpus uteri | |
| Endometrial cystic hyperplasia | |
| Other specified disorders of uterus, NEC | |
| Excessive or frequent menstruation | |
| Puberty bleeding | |
| Irregular menstrual cycle | |
| Metrorrhagia | |
| Disorders of menstruation and other abnormal bleeding from female genital tract, other |
|
| Premenopausal menorrhagia | |
| Postmenopausal bleeding | |
Diagnosis
- Pelvic and rectal examination
- Pap smear
- Pelvic ultrasound scan is the first line diagnostic tool for identifying structural abnormalities.
- Endometrial biopsy to exclude endometrial cancer or atypical hyperplasia
- HysteroscopyHysteroscopyHysteroscopy is the inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention .-Method:...
Treatment
Where an underlying cause can be identified, treatment may be directed at this. Clearly heavy periods at menarcheMenarche
Menarche is the first menstrual cycle, or first menstrual bleeding, in female human beings. From both social and medical perspectives it is often considered the central event of female puberty, as it signals the possibility of fertility....
and menopause
Menopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...
may settle spontaneously (the menarche being the start and menopause being the cessation of periods).
If the degree of bleeding is mild, all that may be sought by the woman is the reassurance that there is no sinister underlying cause. If anemia occurs then iron
Iron
Iron is a chemical element with the symbol Fe and atomic number 26. It is a metal in the first transition series. It is the most common element forming the planet Earth as a whole, forming much of Earth's outer and inner core. It is the fourth most common element in the Earth's crust...
tablets may be used to help restore normal hemoglobin
Hemoglobin
Hemoglobin is the iron-containing oxygen-transport metalloprotein in the red blood cells of all vertebrates, with the exception of the fish family Channichthyidae, as well as the tissues of some invertebrates...
levels.
The condition is often treated with hormones, particularly as dysfunctional uterine bleeding commonly occurs in the early and late menstrual years when contraception is also sought. Usually, oral combined contraceptive
Contraception
Contraception is the prevention of the fusion of gametes during or after sexual activity. The term contraception is a contraction of contra, which means against, and the word conception, meaning fertilization...
or progesterone only
Progesterone only pill
Progestogen-Only Pills or Progestin-Only Pills are contraceptive pills that contain only synthetic progestogens and do not contain estrogen...
pills may be taken for a few months, but for longer-term treatment the alternatives of injected Depo Provera
Depo Provera
Depo-Provera is a branded progestogen-only contraceptive, depot medroxyprogesterone acetate long acting reversible hormonal contraceptive birth control drug that is injected every 3 months...
or the more recent progesterone
Progesterone
Progesterone also known as P4 is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy and embryogenesis of humans and other species...
releasing IntraUterine System
IntraUterine System
The IUD with progestogen, intrauterine system , or IntraUterine Contraceptive is a long-acting reversible hormonal contraceptive device that is placed in the uterus. An IUS has a hormone cylinder that releases a progestin called levonorgestrel...
(IUS) may be used. Fibroids may respond to hormonal treatment, and if they do not, then surgical removal may be required.
Tranexamic acid
Tranexamic acid
Tranexamic acid is a drug used to treat or prevent excessive blood loss during surgery and in certain other conditions...
tablets that may reduce loss by up to 50%. BMJ. 1996 Sep 7;313(7057):579-82.
Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid, and tranexamic acid.
Bonnar J, Sheppard BL.
SourceTrinity College, Department of Obstetrics and Gynaecology, St. James Hospital, Dublin, Ireland.
This may be combined with hormonal medication previously mentioned. Anti-inflammatory
Anti-inflammatory
Anti-inflammatory refers to the property of a substance or treatment that reduces inflammation. Anti-inflammatory drugs make up about half of analgesics, remedying pain by reducing inflammation as opposed to opioids, which affect the central nervous system....
medication like NSAIDs may also been used, but typically cause only a 30% reduction in flow.
A definitive treatment for menorrhagia is to perform hysterectomy
Hysterectomy
A hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total or partial...
(removal of the uterus). The risks of the procedure have been reduced with measures to reduce the risk of deep vein thrombosis
Deep vein thrombosis
Deep vein thrombosis is the formation of a blood clot in a deep vein. Deep vein thrombosis commonly affects the leg veins or the deep veins of the pelvis. Occasionally the veins of the arm are affected...
after surgery, and the switch from the front abdominal to vaginal approach greatly minimizing the discomfort and recuperation time for the patient; however extensive fibroids may make the womb too large for removal by the vaginal approach. Small fibroids may be dealt with by local removal (myomectomy
Myomectomy
Myomectomy, sometimes also fibroidectomy, refers to the surgical removal of uterine leiomyomas, also known as fibroids. In contrast to a hysterectomy the uterus remains preserved and the woman retains her reproductive potential.-Indications:...
). A further surgical technique is endometrial ablation
Endometrial ablation
Endometrial ablation is a medical procedure that is used to remove or destroy the endometrial lining of a uterus. This technique is most often employed for people who suffer from excessive or prolonged bleeding during their menstrual cycle but cannot or do not wish to undergo a hysterectomy. ...
(destruction) by the use of applied heat (thermoablation).
In the UK
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
the use of hysterectomy for menorrhagia has been almost halved between 1989 and 2003. This has a number of causes: better medical management, endometrial ablation and particularly the introduction of IUS which may be inserted in the community and avoid the need for specialist referral; in one study up to 64% of women cancelled surgery.
Medications
These have been ranked by the UK's National Institute for Health and Clinical ExcellenceNational Institute for Health and Clinical Excellence
The National Institute for Health and Clinical Excellence is a special health authority of the English National Health Service , serving both English NHS and the Welsh NHS...
:
- First line
- IntraUterine SystemIntraUterine SystemThe IUD with progestogen, intrauterine system , or IntraUterine Contraceptive is a long-acting reversible hormonal contraceptive device that is placed in the uterus. An IUS has a hormone cylinder that releases a progestin called levonorgestrel...
insertion
- IntraUterine System
- Second Line
- Tranexamic acidTranexamic acidTranexamic acid is a drug used to treat or prevent excessive blood loss during surgery and in certain other conditions...
an antifibrinolytic agent - Non-steroidal anti-inflammatory drugs (NSAIDs)
- Combined oral contraceptive pills to prevent proliferation of the endometrium
- Tranexamic acid
- Third line
- Oral progestogen (e.g. norethisteroneNorethisteroneNorethisterone is a molecule used in some combined oral contraceptive pills, progestogen only pills and is also available as a stand-alone drug...
), to prevent proliferation of the endometrium - Injected progestogen (e.g. Depo proveraDepo ProveraDepo-Provera is a branded progestogen-only contraceptive, depot medroxyprogesterone acetate long acting reversible hormonal contraceptive birth control drug that is injected every 3 months...
)
- Oral progestogen (e.g. norethisterone
- Other options
- Gonadotrophin-releasing hormone (GnRH) agonists (e.g. GoserelinGoserelinGoserelin acetate is an injectable gonadotropin releasing hormone superagonist , also known as a luteinizing hormone releasing hormone agonist. Structurally, it is a decapeptide...
)
- Gonadotrophin-releasing hormone (GnRH) agonists (e.g. Goserelin
Surgery
- Dilation and curettage (D&C) is no longer performed for cases of simple menorrhagia, having a reserved role if a spontaneous abortion is incomplete
- Endometrial ablationEndometrial ablationEndometrial ablation is a medical procedure that is used to remove or destroy the endometrial lining of a uterus. This technique is most often employed for people who suffer from excessive or prolonged bleeding during their menstrual cycle but cannot or do not wish to undergo a hysterectomy. ...
- Uterine arteryUterine artery-Structure:The uterine artery usually arises from the anterior division of the internal iliac artery. It travels to the uterus, crossing the ureter anteriorly, reaching the uterus by traveling in the cardinal ligament....
embolisation (UAE) - Hysteroscopic myomectomyMyomectomyMyomectomy, sometimes also fibroidectomy, refers to the surgical removal of uterine leiomyomas, also known as fibroids. In contrast to a hysterectomy the uterus remains preserved and the woman retains her reproductive potential.-Indications:...
to remove fibroids over 3 cm in diameter
Complications
Aside from the social distress of dealing with a prolonged and heavy period, over time the blood loss may prove to be greater than the body iron reserves or the rate of blood replenishment, leading to anemiaAnemia
Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...
. Symptoms attributable to the anemia may include shortness of breath, tiredness, weakness, tingling and numbness in fingers and toes, headaches, depression, becoming cold more easily, and poor concentration.