Abnormal Uterine Bleeding (Menometrorrhagia) Diagnosis and Treatment

What is the difference between menorrhagia and menometrorrhagia?

Menorrhagia refers to excessively heavy menstrual bleeding. This condition involves losing an unusually large amount of blood during your period.

Menometrorrhagia, on the other hand, describes abnormal uterine bleeding that is irregular, unpredictable, and can occur at any time, not solely during menstruation.

How common is menometrorrhagia?

Many people with abnormal uterine bleeding do not report their symptoms, making it difficult to determine the exact prevalence. Estimates suggest that 10% to 35% of individuals with a uterus may experience abnormal uterine bleeding. However, the actual numbers could be higher. Menometrorrhagia is especially common during perimenopause (the years preceding menopause) and can also occur when menstruation first begins, typically around age 12.

What Are the Signs of Menometrorrhagia?

The symptoms of menometrorrhagia can differ based on the underlying cause. Doctors usually consider any bleeding that deviates from a period lasting five days every 21 to 35 days to be abnormal. If your bleeding pattern is unpredictable, irregular in duration or frequency, or excessively heavy, you may have menometrorrhagia.

Specific signs include:

• Heavy menstrual bleeding (menorrhagia), such as soaking through pads or tampons hourly for several consecutive hours or needing to use multiple products simultaneously.
• Bleeding or spotting at times outside of your menstrual period.
• Prolonged menstrual periods lasting longer than seven days.
• Menstrual cycles that vary in frequency, occurring fewer than 21 days or more than 35 days apart.
• An absence of menstrual periods for longer than three months.
• Vaginal bleeding post-menopause.
• Signs of anaemia, such as fatigue or weakness, are caused by excessive blood loss.

What causes menometrorrhagia?

Abnormal uterine bleeding can stem from hormonal imbalances, benign growths, infections, precancerous or cancerous conditions, medications, or other health issues. Determining the cause requires consultation with a medical professional.

Hormonal Disorders

Hormonal imbalances are one of the primary causes of abnormal bleeding, particularly in individuals nearing menopause or who have just started menstruating. Hormones regulate your menstrual cycle, and even minor disruptions to their balance can lead to irregular bleeding. Contributing factors include:

• Anovulation.
• Thyroid disorders.
• Polycystic ovary syndrome (PCOS).
• Obesity, which can alter hormonal levels.
• Stress, which affects hormone production.

Noncancerous Growths

Benign growths in the uterus can either cause blockages or directly bleed. Examples include:

• Polyps.
• Fibroids.
• Adenomyosis.
• Endometriosis.

Precancer and Cancer

Although rare, menometrorrhagia can be caused by certain cancers, such as:

• Uterine cancer.
• Cervical cancer.
• Vaginal cancer.
• Ovarian cancer.
• Endometrial hyperplasia.

Infections

Both sexually transmitted infections (STIs) and non-sexually transmitted infections can lead to irregular bleeding, including:

• Trichomoniasis.
• Cervicitis.
• Pelvic inflammatory disease (PID).
• Chlamydia.
• Gonorrhoea.
• Endometritis.
• Vaginitis.

Other Medical Conditions

Certain illnesses or physical conditions may contribute to abnormal uterine bleeding, such as:

• Liver or kidney disease.
• Von Willebrand disease or other clotting disorders.
• Pregnancy complications (e.g., ectopic pregnancy, miscarriage).
• Uterine injuries from trauma (e.g., car accidents).

Note: Bleeding during pregnancy is not normal and should be evaluated by a doctor.

Medications

Certain medications can cause irregular bleeding, including:

• Blood thinners and aspirin.
• Hormone replacement therapy (HRT).
• Tamoxifen, a breast cancer medication.
• Intrauterine devices (IUDs), particularly if they are not removed on time.
• Some types of birth control.

Who does menometrorrhagia affect?

Abnormal uterine bleeding can affect nonpregnant individuals during their reproductive years. However, it may also occur in postmenopausal individuals or during pregnancy. Most people with a uterus will experience irregular bleeding at some point in their lives, but it is rarely serious when appropriately treated.

If you have transitioned to menopause, any bleeding should prompt a visit to your doctor, as it is not considered normal. Similarly, bleeding during pregnancy, whether light or heavy, warrants medical attention.

What are the complications of menometrorrhagia?

Though not typically life-threatening, abnormal bleeding can result in complications, such as:

• Anaemia: Significant blood loss can lead to a shortage of healthy red blood cells, causing fatigue and weakness.
• Undiagnosed Conditions: Menometrorrhagia could indicate underlying health issues, such as cancer or other medical problems, which require timely diagnosis and treatment to avoid further complications.

How is menometrorrhagia diagnosed?

To diagnose abnormal uterine bleeding, your doctor will begin by asking questions, such as:

• What events seem to trigger the bleeding?
• How long does the bleeding typically last?
• How heavy is the bleeding?
• How often do you experience bleeding?
• Do you track your menstrual cycles?
• Are there other accompanying symptoms?
• What medications, vitamins, or supplements do you currently take?
• Is there a possibility of pregnancy?

Keeping a record of your bleeding patterns before your appointment can be highly beneficial. Note when you bleed, the duration, the intensity (e.g., spotting, medium, heavy), and any other symptoms you observe during that time.

Your doctor will also perform a physical examination, which may include:

• Pelvic Exam: An assessment to check for abnormalities.
• Pap Smear: This may be recommended if it has been some time since your last screening.

What tests are performed to diagnose menometrorrhagia?

The diagnostic process typically involves:

• Pregnancy Test: To rule out early pregnancy, as light bleeding is common during early stages.
• Blood Tests: These include a complete blood count (CBC) to assess your blood's clotting ability and check for anaemia.
• Hormone Levels Test: This evaluates any hormonal imbalances that might be contributing to abnormal bleeding.
• Pelvic Ultrasound: This imaging test checks for growth in the reproductive organs. A specialised version, called a sonohysterogram (saline-infusion sonography), provides highly detailed imaging of uterine structures like fibroids and polyps.

Additional tests might include:

• Hysteroscopy: A direct examination of the uterine lining using a small camera to identify fibroids, polyps, or potential cancer.
• Endometrial Biopsy: A sample of the uterine lining tissue is collected and analysed for signs of cancer or precancerous changes.

How Is Menometrorrhagia Treated?

Treatment varies depending on the underlying cause. Options include medications or surgical procedures to manage symptoms or address the root cause.

Medications Your doctor May Recommend:

• Birth Control Pills: To regulate the menstrual cycle.
• Progestin: Administered via shot, implant, or intrauterine device (IUD).
• Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Such as ibuprofen to reduce bleeding and discomfort.
• Gonadotropin-Releasing Hormone (GnRH) Agonists/Antagonists: To reduce or temporarily stop bleeding and shrink fibroids.
• Tranexamic Acid: To manage heavy menstrual bleeding.
• Antibiotics: If an infection is the cause of abnormal bleeding.
• Iron Supplements: If there is a concern about anaemia.

Surgical Procedures

If medications are not sufficient, surgical options might be explored, including:

• Hysteroscopy: Removal of abnormal uterine structures such as fibroids or polyps.
• Uterine Artery Embolisation: Reduces blood flow to fibroids, causing them to shrink.
• Myomectomy: Removes fibroids while preserving the uterus and future fertility.
• Endometrial Ablation: Destroys the uterine lining using techniques like lasers, heat, or freezing; not recommended if future pregnancy is desired.
• Dilation and Curettage (D&C): Removes uterine tissue for diagnosis or treatment; the tissue can also be sent for further analysis.
• Hysterectomy: Permanently removes the uterus, typically for cancer or precancer cases, and eliminates the ability to conceive.

It is essential to discuss the risks and benefits of each surgical option with your doctor to understand the potential outcomes fully.

How Can I Reduce My Risk of Menometrorrhagia?

While not all causes of abnormal bleeding can be prevented, you may reduce certain risks by:

• Maintaining a healthy weight, as this helps balance hormones.
• Practising safer sex, including using condoms, to reduce the risk of sexually transmitted infections (STIs).

What Can I Expect If Diagnosed With Menometrorrhagia?

The prognosis largely depends on the underlying cause of your bleeding. Diagnosing the condition may take time or be relatively straightforward, depending on factors such as age, symptoms, and risk levels for specific conditions.

Fortunately, most cases of irregular bleeding are treatable. Follow your doctor's recommendations and report back if treatments aren't working for you. They are there to help manage the condition and minimise its impact on your life.

When Should I See My Doctor?

Consult a medical professional if you experience abnormal uterine bleeding. Symptoms that warrant immediate attention include:

• Extremely long or short, unpredictable periods.
• Changing menstrual products every hour over multiple hours.
• Bleeding between periods, even if it's light spotting.
• Signs of anaemia, such as fatigue, weakness, or shortness of breath.

If abnormal bleeding disrupts your daily life, schedule a visit. You should not feel compelled to double up on menstrual products or miss activities due to heavy or unpredictable bleeding.

Questions to Ask Your Doctor

Consider asking:

• Is my bleeding considered abnormal?
• What might be causing my abnormal uterine bleeding?
• Is my bleeding heavy enough to increase my risk of other health complications, like anaemia?
• What are the pros and cons of the treatments available to me?
• Which treatment is best if I wish to have children in the future?
• Will I need care from other specialists as part of my treatment?
• Do you routinely treat patients with this condition?

Note

You know your body best—how long your periods typically last and the normal intensity of your bleeding. If you notice changes, such as heavy periods, longer durations, or bleeding outside of your menstrual cycle, don't ignore it. These aren't issues to simply endure. Seek advice from a doctor, especially if it's affecting your mental or physical health. Many noninvasive treatments can help you regain control and improve your quality of life.

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