In clinical practice, patients often come to the clinic because of the number of menstrual periods, among which the number of “menorrhagia” is relatively high. Heavy menstruation is often caused by a disease, but what is the cause of menorrhagia? Does it mean that menopause is imminent?
What is menstruation?
Menstruation is the periodic shedding and bleeding of the endometrium that accompanies the periodic ovulation of the ovaries. The first menstruation is an important sign of puberty, suggesting that the ovaries produce enough estrogen to cause the endometrium to proliferate. When estrogen reaches a certain level and fluctuates significantly, it causes the endometrium to shed and menstruation to occur. Therefore, in essence, menstruation is blood.
What is normal menstruation?
Menstruation has four basic elements: a menstrual cycle of 21-35 days, with an average of 28 days, and a period of 2-8 days, with an average of 4-6 days. The volume of menstruation is the total amount of blood lost during one menstrual period. Normal menstruation is mostly 20-60ml, and more than 80ml is considered excessive menstruation.
What are the main components of menstruation?
95% of menstrual blood comes from venous and arterial blood, the rest is fluid and cellular debris exuded between tissues, inflammatory cells, cervical mucus and shed vaginal epithelial cells. The color of menstrual blood is dark red. As soon as menstrual blood is produced, it has to be expelled, unless there is an obstruction. There is no reason why there are toxins in the body that need to be expelled from the menstrual blood. Usually, when there are no structural changes, the low menstrual bleeding is not a problem of other blood being “held” somewhere in the body and unable to be expelled. Therefore, in general, if there is no specific organic disease and no fertility requirements, it should not be treated, while excessive menstruation is excessive blood loss and requires active attention.
What is excessive menstruation and menorrhagia?
Excessive menstrual flow of more than 60 ml in a menstrual cycle is considered as excessive menstruation, while less than 20 ml is considered as scanty menstruation. When a patient comes to the doctor with a menstrual flow problem, the doctor will often ask: “Has your flow decreased or increased by 1/2 compared to the original? How many sanitary napkins do you use per day? How often do you change one? Does each piece get wet?” When asking patients with low menstrual flow: “Do you have abdominal pain during your period? Can you wet a sanitary napkin at most? Is it okay to use only pads?” The patient’s answer is highly subjective and it is impossible for the doctor to accurately measure the amount of menstruation, but only to make an approximate assessment based on the patient’s account. An approximate estimate of the amount of sanitary napkins is based on the fact that a normal amount is changed on average 4-5 times a day, with no more than 2 packs (10 pads) of sanitary napkins per cycle. If more than 3 packs of sanitary napkins are not enough, and almost every sanitary napkin is wet, it is considered excessive menstruation. Therefore, the amount of menstrual flow is often ambiguous, especially in the case of hypomenorrhea, and only some tests can be done if the organic disease is not very specific.
Causes of excessive menstruation
Excessive menstruation is often a clinical manifestation of certain diseases, the common diseases are.
1. Submucosal fibroids: fibroids that grow convexly in the uterine cavity will increase in menstrual flow because the surface of the fibroids is covered with endometrium, which increases the area of the endometrium. In addition, the occupancy of the fibroids in the uterine cavity can affect the discharge of menstrual blood, causing abnormal contractions of the uterus and producing menstrual pain. It often causes anemia, infertility, etc.
2, endometrial hyperplasia, endometrial polyp: due to endocrine disorder, high estrogen level and long-term anovulation in patients, the endometrium proliferates excessively and protrudes into the uterine cavity, smooth, flesh-like hardness, the length of the tip varies, and the long ones can protrude into the external cervical opening. It often manifests as increased menstrual flow, prolonged periods, dysmenorrhea, infertility, and diagnosable by ultrasound.
3, uterine adenomyosis: endometrium appears and grows in the myometrium is called uterine adenomyosis, its cause is the increase of estrogen level in the body, resulting in excessive hyperplasia of the endometrium, spreading to the myometrium, its cause may be pregnancy and childbirth and excessive scraping and other trauma, obstruction of the reproductive tract so that menstrual blood can not be drained outward, endometrial extrusion into the myometrium. The uterus enlarges and the endometrial area increases; the myometrium becomes hypertrophic, loses its contractility and is unable to control the filling vessels, resulting in more bleeding. It is often manifested as: increased menstrual flow, dysmenorrhea, and enlarged uterus.
4, due to intrauterine device: IUD is a contraceptive device placed in the uterine cavity. It originally belongs to the human body foreign body, and the foreign body in the body can cause local tissue mechanical damage and chronic inflammation. In particular, the birth control ring containing copper ions is cytotoxic and hemolytic. Clinical manifestations are increased menstrual flow accompanied by discomfort in the lower back and abdomen.
5, inflammation: When there is pelvic inflammation, mainly endometritis, the local blood vessels become fragile, the bleeding is not easily coagulated during menstruation, and the menstrual flow is often excessive.
6, blood system diseases: thrombocytopenic purpura, leukemia, hemophilia, aplastic anemia, etc.
7.Some drugs: wrong or missed contraceptive pills, etc.
Treatment of excessive menstruation
Mainly after the symptoms and signs and auxiliary examination, to find the original disease, for the treatment of the original disease.
1, adenomyosis treatment: for young patients who do not have children, actively promote pregnancy; for young people without childbearing requirements can apply levonorgestrel intrauterine device every 24h release 20ug levonorgestrel, valid for 5 years, levonorgestrel can make estrogen receptor synthesis is inhibited, indirectly inhibit the proliferation of ectopic endometrium and make it atrophy, reduce bleeding. Hysterectomy is feasible for those who are willing to undergo surgical treatment without fertility requirements.
2, endometrial hyperplasia, endometrial polyps: for patients with simple or complex endometrial hyperplasia, medication or levonorgestrel intrauterine device can be applied, see the chapter on endometrial lesions for details. For endometrial polyps, hysteroscopic excision of polyps can be applied to prevent recurrence, and levonorgestrel IUD can be applied.
3, the application of intrauterine device: a small amount of bleeding does not require treatment, menstrual flow with hemostatic application of 6-aminoacetic acid hemostatic treatment, ineffective removal of the ring, bleeding for a long time, the application of antibiotics anti-infective treatment.
4, inflammation: the application of anti-inflammatory drugs for treatment.
5, blood system diseases: long-term increased menstrual flow, by the gynecologist examination did not find any cause, we should consider the blood system examination, to exclude blood system diseases. Refer to hematology for treatment after the diagnosis is confirmed.
Why people are more afraid of menorrhagia?
They are afraid that the decrease of menstruation will affect the elimination of toxins in the body, which will cause chloasma, wrinkles and bags under the eyes, and then gradually amenorrhea, premature aging and premature menopause. They keep asking about the causes of low menstruation and take all kinds of herbs and health supplements to solve this problem.
Causes of menorrhagia
1. Problems in the discharge channel: After abortion, the uterine cavity and cervical adhesions cause poor menstrual flow, which is manifested as low menstrual flow, accompanied by dysmenorrhea. The history of abortion can be found in the medical history.
2, endometrial damage: abortion surgery scrapes the endometrium of the basal layer of the uterus, especially painless abortion, due to intravenous anesthesia, the patient is painless, often too serious suction and scraping, serious damage to the endometrium. Some people say that medical abortion is safer and avoids the operation of uterine surgery. However, if the abortion is incomplete, the bleeding time will be prolonged, which will not only cause anemia but also cause infection in the uterine cavity and damage to the endometrium as well when removing the uterine residue. We would like to urge you to use strict contraception when you do not want to have children, because endometrial damage can directly lead to infertility. It is difficult to treat.
3. Infection with tuberculosis: Infection of the endometrium with tuberculosis can cause damage to the endometrium, resulting in reduced menstrual flow and even amenorrhea. Some patients suffer from pelvic tuberculosis since childhood, but they are not aware of it and often consult the doctor with primary amenorrhea. These patients have severe damage to the endothelium and have difficulty conceiving despite successful anti-TB treatment.
4.Ovarian hypofunction: When the ovaries are hypofunctional, the estrogen level decreases, which affects the proliferation of the endometrium and reduces menstrual flow. The diagnosis can be made clearly by measuring FSH, LH and E2.
5. Endocrine diseases: hyperprolactinemia, polycystic ovary syndrome and abnormal thyroid function can cause a decrease in menstrual flow or even amenorrhea. The diagnosis can be confirmed by hormone measurement.
6.Drugs: taking contraceptive pills and psychiatric drugs can reduce menstrual flow.
Treatment of menorrhagia
1, cervical and uterine adhesions: separation of adhesions by hysteroscopic surgery, intra-uterine insertion of a birth control device, post-operative application of estrogen for 3 months for endometrial repair, and hysteroscopic examination after 3 months to assess the endometrial condition.
2. Infection with tuberculosis: Diagnosis relies on endometrial biopsy and for patients with tuberculosis who are in the active stage, they should be treated with anti-tuberculosis. Unfortunately, there is no way to make the endometrium grow because the basal layer of the endometrium has been destroyed and the endometrium does not respond to estrogen, so the application of more estrogen cannot change the menstrual problem.
3. Hypovarianism: For patients with reduced menstrual flow due to hypovarianism, it is impossible to increase menstrual flow by changing ovarian function, and the ovarian maintenance currently promoted is extremely unscientific. However, we can apply hormone replacement to supplement estrogen to make the endometrium proliferate and increase the menstrual volume.
4. Endocrine diseases: treatment of related diseases is sufficient. Patients with polycystic ovary syndrome can lose weight and at the same time apply Daine-35 to lower androgen and restore regular menstruation; patients with hyperprolactin apply bromocriptine to lower prolactin, restore ovulation and resume menstruation.
In conclusion, for patients with reduced menstrual flow with fertility requirements, treatment is based on the etiology, where fertility is difficult to achieve in patients with endometrial tuberculosis and ovarian hypofunction. For patients without fertility requirements, no uterine or cervical adhesions, no endocrine diseases, and normal ovarian function, reduced menstrual flow is not a big problem. Many patients think that menstrual blood can expel toxins, and reduced menstrual flow makes toxins poorly expelled, which affects health and causes facial pigmentation and poor complexion. In fact, menstruation is just a phenomenon, and it does not matter how much. Patients with endometrial tuberculosis without fertility requirements do not need to treat amenorrhea at all as long as their ovaries are functioning normally. In patients with declining ovarian function, any treatment that attempts to correct ovarian function is not helpful, that is, we know that ovarian function is going into decline, but we are powerless to stop it and have to let it progress. However, we can use hormone replacement to supplement estrogen and achieve regular menstruation. See the chapter on hormone replacement therapy for more details.