Science

Heavy menstruation (menorrhagia): definitions, symptoms, treatment

If you have very heavy periods, so heavy that you have to change the protection every two hours, or if they last seven days or more, you may be suffering from menorrhagia. A source of fatigue and pain, they can be treated effectively and quickly in the office.

Definition

Menorrhagia refers to abnormally heavy menstruation. They should not be confused with metrorrhagia, which is bleeding outside the period, or with metromenorrhagia, where irregular bleeding no longer makes it possible to know when the period has come.

Menorrhagia is usually referred to when menstrual bleeding lasts 7 days or more and/or more than 5 tampons or pads per day are required for discharge. But this definition is “very subjective,” Prof. Fernandez notes. “We therefore propose the Higham scale, which I believe should be offered in all consultations.” This test consists of a table that must be completed at each diaper change within one day of menstruation. A soiled towel or tampon is worth, for example, 1 point, half-full protection is worth 5, and full protection is 20 points. A score of more than 100 points or a blood loss of more than 80 milliliters indicates menorrhagia. 80 ml corresponds to “about 5 filled medium size UPCs, or more than 5 super plus tampons, or more than 5 super plus sanitary napkins”, specified by Hospices Civils de Lyon (HCL).

The reasons

“In the vast majority of cases, menorrhagia is caused by (de)benign uterine lesions such as fibroids or uterine polyps,” explains HCL. “It is not the endometrium that bleeds, but an intracavitary lesion (in the uterus, editor’s note) that alters vascularity and causes bleeding,” explains Professor Fernandez.

But heavy periods can also be associated with endometriosis, a genetic clotting defect, or caused by medication or hormonal imbalances.

Symptoms

Among the symptoms, in addition to genital bleeding, there are fatigue, pain (bloating, abdominal cramps), anemia (iron deficiency due to blood loss) or uro-digestive disorders caused by fibroid pressure on the bladder or small intestines. Fertility can also be affected, especially if the uterus is deformed.

WHEN TO CONSULT? If your period lasts more than 7 days or you have to double your hygiene protection and change it every two hours, experts can help you.

Menorrhagia is common, as it affects one woman aged 35 to 55 in five in Europe, i.e. approximately 2 million French women. Unfortunately, 50 to 70% of them do not consult, “because they are embarrassed, think it is normal or do not know that there are solutions,” says Prof. Hervé Fernandez, head of the maternity ward of the Kremlin-Bicêtre (AP-HP) . , Paris).

Care

HORMONES. Hormonal treatment with a progestogen, such as an intrauterine device, may be suggested. “The advantage of this type of treatment is that it is also a contraceptive,” says Dr. Vincent Villefranc, gynecologist and head of service at the Auunne-Montmorency Hospital Group. “However, many women today refuse to take hormones.” Surgical treatments can then come into play, ranging from microsurgery to removal of the uterus (hysterectomy).

SURGICAL. “For a very long time, hysterectomy after 40 was a common practice. But the loss of the uterus can be painful for some women, who see it as a symbol of femininity, ”says Dr. Villefranc. “Especially since this procedure requires several days of hospitalization and a month of vacation.” Tough times for many women. In France, 172 hysterectomies per 100,000 patients were performed in 2019, compared to 240 in Germany and 95 in Ireland. “With a good preliminary investigation, we should not exceed 50,” Dr. Wilfranc says. But the remuneration terms for hospitals changed in September 2020 and now allow institutions to find their way financially even while operating off the block. This measure is already encouraging more people to abandon surgery in favor of microsurgery, which is much faster and less drastic.

MICROSURGICAL. This type of treatment has been around for 30 years, but its cost, considered a waste by hospitals, held back its adoption until a reform in September 2020. However, some microsurgical methods can solve the problem of menorrhagia in a short time, with a simple local anesthesia! The choice of method essentially depends on whether the patient wants to preserve the ability to bear children or not. If pregnancy is desired, the doctor will not suggest a method for destroying the endometrium. Hysteroscopy, a camera inserted into the uterus, allows the lesion to be visualized and intervened directly with sensors. “In 30 minutes, we can remove a tumor or destroy the endometrium, and the patient can immediately go home,” says Dr. Wilfranc.

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