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