Metrorrhagia - what is it? Causes, symptoms, treatment

Metrorrhagia or uterine bleeding is considered a life-threatening condition. Doctors rarely diagnose this phenomenon in girls who are newborns, younger than 10 years old, or during puberty. But in most cases, this diagnosis is recorded in women during the reproductive period and menopause. Any bleeding not related to menstruation requires immediate medical attention. Self-medication is dangerous.

Causes of menorrhagia

Physiological factors for the development of menorrhagia (hypermenorrhea) include:

• frequent stressful situations;
• overwork, constant work without days off;
• excessive physical activity, especially a few days before the onset of menstruation;
• changes in the nature of nutrition, the predominance of fermented milk products in the diet;
• moving to another climate zone;
• hormonal changes during puberty and premenopause.

They cause short-term cycle disturbances and are not accompanied by a deterioration in the woman’s general condition. Often, such factors do not require treatment, and after normalizing the lifestyle, the unpleasant symptoms disappear.

Idiopathic menorrhagia occurs extremely rarely when doctors are unable to identify a single provoking factor.

Pathological causes of the development of menorrhagia in women include a large group of diseases:

1. Inflammatory diseases of the genital organs: cervicitis, endometritis, salpingo-oophoritis, tubo-ovarian formation.
2. Infectious pathologies: thrush, chlamydia, genital herpes, ureaplasmosis, gonorrhea.
3. Benign neoplasms: endometrial polyps, ovarian cysts, submucosal fibroids.
4. Cancer of the cervix, uterine body, and ovaries.
5. Ectopic pregnancy.
6. Anovulatory cycles in hyperprolactinemia syndrome, PCOS, hormone-producing tumors.
7. Placement or removal of intrauterine devices for contraception.
8. Blood clotting disorders: uncontrolled use of anticoagulants, decreased synthesis of vitamin K, thrombocytopenia.
9. Diseases of the endocrine organs: thyroid gland, adrenal glands, hypothalamic-pituitary system.
10. Spontaneous use of hormonal contraceptives, antiestrogenic drugs, tricyclic antidepressants.

A separate group includes risk factors: a history of miscarriages, medical abortions and premature births, hypertension, obesity and metabolic syndrome. Sometimes hereditary forms of the disease are observed, when all women in the family suffer from heavy periods.

Signs by type

Gynecologists divide uterine bleeding into three groups depending on the causes of its occurrence. The first type includes dysfunctional metrorrhagia of the ovulatory and anovulatory type. It occurs at any age due to disruption of the ovaries, uterus or glands associated with the reproductive system. These bleedings are caused by illness, hormonal imbalance, stress or medication.

Reference! Blood discharge can be abundant, moderate intensity or scanty, regardless of the type of metrorrhagia. Often accompanied by pain, deterioration of well-being, and signs of cardiovascular disease.

Dysfunctional bleeding is characterized by frequent relapses. Signs of ovulatory type metrorrhagia include normal ovarian function. In anovulatory form, the egg does not mature and the corpus luteum does not form.

Signs and symptoms of dysfunctional metrorrhagia:

• heavy bleeding for more than 7 days,
• increased amount of blood released during menstruation,
• critical days are longer than usual,
• spotting or bleeding between periods,
• development of anemia (pale skin, weakness),
• exhaustion (weight loss, circles under the eyes),
• hypotension,
• increased heart rate,
• short-term delays in menstruation (violations of the menstrual cycle),
• shortening the cycle to less than 21 days.

The second type includes organic metrorrhagia. Uterine bleeding occurs due to diseases that change the tissue structure or anatomy of the affected organ. This is the growth of the endometrium, cancer, benign tumors, inflammatory and other processes in the reproductive system. The pathology is characterized by sudden intermenstrual bleeding from the uterus of any profusion.

Organic metrorrhagia:

• can occur on any day of the cycle,
• vary in duration,
• more often they go abundantly (the pad is changed 1-2 times/hour).

The third group includes obstetric bleeding, that is, associated with pregnancy and childbirth. They are a sign of injury, complications of gestation or childbirth. Untimely treatment ends in miscarriage, risking the life of the mother. Rarely, these types of metrorrhagia are not accompanied by pain in the lower abdomen. In case of ectopic pregnancy, analgesics do not work, toxicosis is possible. Dark blood with clots comes after a 4-12 day delay in menstruation, the woman quickly loses consciousness.

How does menorrhagia manifest?

The main symptom is an increase in the volume of blood that is released during one menstruation. A woman cannot estimate the amount of fluid in milliliters, so to objectively assess menorrhagia, gynecologists ask how often pads or tampons need to be changed.

The norm is to change hygiene products (category Normal) every 3-4 hours, and on the first or second day it is acceptable to use a new pad every 2-3 hours.

If the volume of discharge is not much higher than the standard, the woman feels well and often does not see a doctor. It is known that more than 40% of patients with menorrhagia consider their condition to be normal.

With massive menstrual bleeding and regularly recurring hypermenorrhea, the following symptoms are possible:

• weakness, increased fatigue;
• dizziness, darkening of the eyes;
• pale skin;
• frequent nose and gum bleeding;
• causeless appearance of bruises;
• inability to get pregnant.

Characteristic signs indicating problems with the reproductive system are discomfort and pain during menstruation. PMS may intensify and its duration may increase. A painful menstrual cycle occurs with thrush, inflammation of the uterus and appendages, and endometriosis.

Dysfunctional bleeding

Metrorrhagia, the causes of which, as it turned out, can be different, is divided into several types: dysfunctional, organic and obstetric.

Dysfunctional bleeding in gynecology occurs due to impaired secretion of ovarian hormones. Due to hormonal disorders, hyperplasia appears, which is the growth of the inner layer of the uterus - the endometrium. Over time, the hyperplastic endometrium is rejected, and it is this long process that is accompanied by random non-cyclic bleeding, lasting up to several weeks.

Physical overload, severe stress, taking certain medications and climate change can provoke and even aggravate dysfunctional metrorrhagia. With prolonged dysfunctional bleeding, there is a high probability of developing anemia. Typically, women suffering from this disease feel constant drowsiness, increased fatigue and have a rapid heartbeat, low blood pressure and pale skin.

Menorrhagia in adolescents

During puberty, the problem is called juvenile (dysfunctional) uterine bleeding. They occur in girls aged 12–18 years, most often in the first 3 years after the onset of menstruation.

Menorrhagia in adolescents occurs due to hormonal fluctuations: during the development of secondary sexual characteristics and endometrial maturation, an imbalance is observed between the levels of progesterone and estrogen. As a result, excessive rejection of the uterine mucosa occurs during menstruation, the vessels contract worse, so bleeding sometimes lasts up to 10–20 days.

Diagnosis and treatment of adolescent menorrhagia is of paramount importance. If the problem is not identified in time, the risk of developing polycystic ovary syndrome, anovulatory cycles and infertility increases sharply.

What it is?

In gynecology and obstetrics, metrorrhagia refers to copious or scanty discharge of blood from the genital tract, which is not related to menstruation. This condition may coincide with the period of menstruation or not; it has an acyclic form. You need to learn and know how to distinguish the disease from menstruation. You should also be examined if your critical days last more than 5–7 days without stopping, the discharge has changed (became bright red, with clots or watery), or there are other abnormalities.

In the ICD-10 reference book, metrorrhagia was included in the heading “Abnormal bleeding from the vagina or uterus” under code N93.0–93.9 . This includes spotting for specified or unknown reasons, and after sexual intercourse.

The gynecologist may also use other codes for uterine bleeding:

• in the postmenopausal period - N95,
• before/during/after childbirth - O46, O67 or O72,
• pseudomenstruation in a newborn - P54.6,
• cycle disturbance, frequent, heavy menstruation - N.

Bleeding from the genital tract is considered a cause of infertility. The menstrual cycle (MC) begins with the cleansing of the uterus from old endometrium. With the advent of menstruation, the reproductive cell begins to mature in the ovary. In the middle of the MC, ovulation occurs and the luteal gland is formed in the burst follicle. This corpus luteum synthesizes the “motherhood hormone” progesterone. It stimulates the growth of new endometrium. The usefulness of the intrauterine mucosa determines whether the fertilized egg can attach normally to the wall and whether the placenta will form correctly.

Metrorrhagia affects the process of preparing the uterus for implantation and bearing a child. During bleeding of any profuseness, the thickness of the endometrium is reduced and the nutrition of the tissue is disrupted. This prevents the fertilized egg from properly implanting into the wall of the organ and the pregnancy fails. In case of successful implantation, the risk of developing placental insufficiency remains. Its consequences include miscarriages, oxygen starvation or fetal death, and other complications of gestation.

Important! Metrorrhagia is dangerous for a girl or woman due to the risk of death from excessive blood loss. The phenomenon also applies to signs of cancer, complications of pregnancy or childbirth: these pathologies also threaten the health and life of the patient.

Diagnosis of menorrhagia

The examination of a woman begins with a standard interview with a gynecologist. The doctor finds out information about the time of the onset of menstruation, their regularity and abundance, the presence of PMS and painful cramps during the cycle. A woman needs to keep a menstrual calendar in order to quickly provide the doctor with the necessary information at the appointment. Next, the specialist will ask about sexual activity, history of pregnancies and childbirth. You need to answer honestly, since minor details can help in making a diagnosis.

The second stage in the diagnosis of menorrhagia is a standard gynecological examination on a chair with examination of the genital organs in the speculum and bimanual palpation.

To determine the causes of pathological menstrual bleeding, additional laboratory and instrumental methods are prescribed:

• Ultrasound examination of the pelvic organs (transvaginal or classical method);
• colposcopy;
• hysteroscopy;
• diagnostic curettage;
• complete hormonal profile in phases 1 and 2 of the cycle;
• coagulogram;
• vaginal smear for microflora;
• PCR research;
• oncocytological analysis of a smear from the cervix;
• histological examination of biopsy specimens.

Hysteroscopy

During hysteroscopy, the walls of the uterus are examined using a special instrument equipped with an optical system. The procedure allows you to diagnose and simultaneously eliminate any violations. The hysteroscopy procedure is performed in a hospital or on an outpatient basis. The effectiveness of the operation is up to 85%. Before the intervention, the patient’s Rh factor and blood type are determined, a gynecological smear is taken, as well as tests for hepatitis B and syphilis.

Treatment of menorrhagia

Therapeutic measures are selected taking into account the cause of the pathology, the patient’s well-being, and the presence of chronic reproductive diseases. In order for medical prescriptions to give a good result, it is necessary to change your lifestyle: get more rest, try to avoid stress and overwork, and adjust your diet. Without following these rules, it will be more difficult to normalize the cycle.

Drug treatment for heavy menstruation

To eliminate massive menstrual bleeding, several groups of drugs are used:

1. Hormones. Combined oral contraceptives reduce the volume of discharge by an average of 40%, prevent excessive growth of the endometrium of the uterus and reduce the painful symptoms of PMS. These are modern methods of treating menorrhagia.
2. NSAIDs. Anti-inflammatory drugs inhibit the formation of prostaglandins, resulting in a decrease in the duration and intensity of menstrual flow. Medicines relieve pain and cramps during menstruation.
3. Hemostatics. Treatment of menorrhagia with aminocaproic acid and other hemostatic drugs is carried out in severe cases, when the volume of uterine discharge reaches 300–400 ml. Medicines are prescribed in short courses to activate the functions of the blood coagulation system.
4. Iron supplements. With heavy discharge, the body does not have time to restore the number of red blood cells and hemoglobin, so for the treatment of anemia, oral iron-containing drugs are prescribed in long courses (at least 3-4 months).

Treatment of juvenile bleeding in teenage girls is carried out with low-dose hormonal drugs. They do not harm the reproductive system, help maintain the balance of estrogen and progesterone, and regulate the frequency and duration of menstruation.

Herbal medicines and vitamin therapy are used as an auxiliary method of therapy. Natural remedies participate in the regulation of hormonal levels and improve the functioning of all internal organs. Physiotherapeutic methods of treatment are occasionally prescribed: diadynamic therapy, ozokerite applications, electrophoresis.

Surgical treatment of menorrhagia

Surgical interventions are prescribed for serious tumor and inflammatory pathologies, confirmed by test results and ultrasound. Absolute readings:

• ineffectiveness of conservative therapy;
• heavy and recurrent uterine bleeding;
• severe forms of iron deficiency anemia;
• malignant neoplasms.

Surgical treatment is more often prescribed to women over 40 years of age who are not interested in preserving reproductive function. Curettage of the uterine cavity, its removal (hysterectomy) or supravaginal amputation is performed. Sometimes it is necessary to remove appendages from one or both sides.

Hysterectomy

Menorrhagia (we found out what it is) is treated with a surgical method such as hysterectomy - this is the removal of the uterus, which is carried out through the vagina or a small incision in the abdominal cavity. This type of surgical intervention is performed extremely rarely on young women, only in exceptional cases, since it is impossible to become pregnant after a hysterectomy.

This operation, according to patients, brings significant relief, sexual desire does not decrease, sex life remains at the same level, and even becomes brighter. The advantages of the operation include the fact that the patient’s body recovers very quickly (within a few days), and there are no significant surgical scars. From the practice of hysterectomy, we can conclude that in most cases the cycle stops after surgery, the discharge no longer bothers us, and over time, menopause occurs.

Prevention of menorrhagia

To prevent abnormal menstrual bleeding, a woman should adhere to the following rules:

• maintain a healthy lifestyle, which includes a balanced diet and physical activity, giving up bad habits;
• carefully monitor the hygiene of the genital organs, especially during menstruation;
• keep a menstrual calendar, where you note the duration and approximate amount of discharge, your well-being and mood;
• use reliable contraception; when changing sexual partners frequently, it is optimal to use barrier methods (condoms);
• Visit your gynecologist annually for a preventive examination.

Folk remedies

Menorrhagia - what is it and is it possible to relieve the symptoms of the disease using folk methods? In some cases, yes, you can resort to grandmothers’ recipes to alleviate the condition, but it is necessary to treat the causes of the disease only under the supervision of a doctor.

Fezalis tincture gives a positive effect. It is prepared in advance. It is necessary to infuse dried fesalis roots (50 g) in half a liter of vodka. The medicine is infused for two weeks, the contents must be shaken periodically. You need to take 20-30 drops before meals three times a day.

Take dry raspberry leaves, chop them, pour boiling water (half a liter) into three tablespoons. The medicine is infused for up to six hours, wrapped. Four times a day you need to drink half a glass of the decoction warm.

Make a collection, it will include: leaves of white amela, blackberry, shepherd's purse herb. You need to take 50 g of the collection, a liter of dry red wine, and mix. After five hours, bring the mixture to a boil. Next, everything needs to be cooled and then strained. The product should be taken three times a day, 50 ml.

In any case, if you have menorrhagia, be sure to consult a gynecologist for help. The human body is a complex system, each one is unique. It may turn out that the means that helped one may harm another. Only a doctor, using the correct diagnostic methods, can accurately identify the cause of the disease and prescribe the correct treatment.