Menorrhagia is a symptom of an underlying pathology in many women. It is defined as excessive bleeding (over 80 ml of blood per period), for over 7 days and at regular intervals.

Causes of Menorrhagia

Causes of Menorrhagia may be due to specific disease, hormonal, uterine or reproductive anatomical abnormalities or caused due to drugs etc.

Diagnosis of the underlying condition is based on these causes.

History of the condition

Examination begins with a detailed history of the condition.

Patient is asked to maintain a menstrual diary to record the time and duration of her periods.

She needs to keep a record of the number of pads or tampons used to assess the amount of blood loss.

History of similar episodes in the family, use of certain drugs like Warfarin, age, use of intrauterine contraceptive devices is also important to pin point the cause of heavy bleeding. (1-5)

Physical examination

After history a complete physical examination is undertaken.

Medical disorders, liver, kidney disease, thyroid problems, bleeding disorders may be detected by clinical examination.

A vaginal examination may be needed. The doctor may insert one or two gloved, lubricated fingers into the vagina and gently feel for some anatomical abnormality. (1-5)

Differential diagnosis

Other diagnosis should be considered. These include abortion, tumors of the female reproductive organs, adrenal gland tumors and cancers, lack of ovulation, cervix inflammation, uterus cancer, cervix cancer, hyper or under active thyroid, pituitary tumors, pelvic infections, pregnancy vaginal inflammation etc. (1)

Diagnosis process

The work up for Menorrhagia includes (1-5) –

• Complete and routine blood tests – These include test for haemoglobin. A low haemoglobin signifies anemia due to excessive blood loss.

  Iron assessments in blood may also help detect anemia.

  Increased White Blood Cell count may signify pelvic inflammations.

  Platelet count and assessment of coagulation of blood may help detect bleeding disorders.

  Thyroid function tests and prolactin level helps detect problems of the thyroid gland and pituitary gland that may be causing menstrual abnormalities.

  Liver function and kidney function tests are used to detect underlying liver or kidney disorders.

• Pregnancy should be excluded by routine pregnancy tests.
• Hormone assays like assessment of LH (luteinizing hormone), FSH (follicle stimulating hormone), estrogen and progestrones are done to exclude hormonal disorders
• Imaging studies may be included to rule out organic diseases.

  Pelvic ultrasound is conducted to detect fibroids, polyps etc. Hysteroscopy is used to directly visualize the uterine cavity.

  A biopsy or a small amount of uterine tissue may be taken for examination under the microscope. This may be used to rule out uterus cancer.

• Papanicolaou (Pap) smear test is used to detect and rule out cervical cancers.
• Some patients may need a Dilation and curettage (D&C) procedure. The physician dilates the cervix and then inserts a spoon-shaped instrument called the curette into the uterus to collect tissues. The tissues are then examined under the microscope.