Menorrhagia is defined as excessively heavy or prolonged bleeding. The average amount of blood loss during a normal menstrual period is 40 to 50 ml. With Menorrhagia, a woman may lose 80 ml or more.
Menorrhagia is abnormal bleeding from the uterus, and may be caused by either medical problems or hormone imbalances. In a normal menstrual cycle, there is a balance between the hormones oestrogen and progesterone. These hormones regulate the build-up of endometrium (the lining of the uterus or womb), which is shed each month during menstruation.
Menorrhagia can occur because of an imbalance between oestrogen and progesterone. As a result of this, the endometrium keeps building up. When it is eventually shed, you get heavy bleeding. Because hormone imbalances are often present in adolescents and in women approaching menopause, this type of menorrhagia (known as dysfunctional uterine bleeding) is fairly common in these groups.
Uterine fibroids (growths) are another frequent cause of menorrhagia. Together, hormone imbalances and fibroids account for about 80% of menorrhagia cases.
Signs & Symptoms of Menorrhagia:
- Excessive Menstrual Flow (will vary greatly from woman to woman).
- Menstrual Periods last more than 7 days
- Large Clots may be passed
- Paleness and fatigue (anaemia)
Treatment available for Heavy Periods
- Oral Contraceptive Pill
- Tranexamic Acid
- Mirena Intrauterine System
Mirena is an intrauterine system (IUS), which is inserted by a trained doctor into the womb. It consists of a small, plastic, T-shaped frame, surrounded by a tiny cylinder, which contains the hormone, levonorgestrel. Levonorgestrel is a type of progestigen. This hormone is released slowly into the uterus over an interval of 5 years.
Mirena (IUS) in the treatment of heavy periods
The intrauterine system releases a small amount of hormone locally into the womb. This hormone has the effect of suppressing the lining of the womb (endometrium), so that there is no build-up. This means that there is then very little endometrial lining to be shed in the monthly period.
As a result, there is a dramatic decrease in the volume and duration of the period. Because of this, many gynaecologists now suggest the Mirena as a treatment for heavy periods. Studies show that after 3 months’ use, the average blood loss is reduced by 80%, and, by 12 months, the blood flow is reduced by 95% every cycle.
About one third of women using the Mirena will not have any period at all. Although women initially find not having periods a bit unusual, of itself, this doesn’t cause any problems. There is no ‘build up’ of blood because the hormone in the IUS prevents the lining of the womb from building up at all. Often, it is the excessive thickening of this lining that is the cause of the problems in the first place.
A number of medical procedures can be used to treat heavy menstrual bleeding. However, many studies have shown Mirena to be more effective in the long term than any of these.
There are also two surgical treatments: hysterectomy and endometrial ablation – a procedure which involves the removal of the uterine lining. In some cases, Mirena may actually reduce the need for hysterectomy. One particular study revealed that 65% of women who had a Mirena inserted while awaiting hysterectomy decided not to go ahead with the operation. Dr. McCaffrey will of course advise you on all of the options available.
Most women can use Mirena, but as with other treatments, it will not be suitable for everyone. You can discuss your options with your doctor.
The level of hormone released into the blood stream is very low, so that side effects such as breast tenderness, headaches and acne are rare. If they do occur, they will usually disappear after the first few months. Many women experience spotting or light bleeding in addition to their periods for the first 6 to 12 weeks after the system is fitted.
Only a specially trained doctor can fit the system. This is usually done during your period (days 3-7). Your doctor will give you a pelvic examination to find the position and size of your womb before the Mirena is fitted. Most women find that fitting causes only mild discomfort (a little like a smear test). Afterwards, you may feel a little cramping, like a period pain, but this should disappear after a few hours. Preparations for fitting usually take about 5 minutes, but the actual fitting itself takes only a few seconds.