Menorrhagia is the medical term for heavy menstrual bleeding but it has many definitions. The textbook definition would be described as blood loss at a rate of greater than 80 ml per cycle, but the more practical definition that every woman can understand would be best described as soaking a maxi pad or tampon every 2 hours.
Personally, I prefer to let the patient decide what is too much. But, if the amount of bleeding is affecting or changing her usual routines, then I would say it is time to consider therapies to lighten or shorten her menstrual cycles.
The first step in determining an appropriate treatment for the patient is to identify the cause of the heavy bleeding. Causes can vary widely based on age, medical history, medication usage, nutritional status and even stress levels.
Menstrual bleeding originates in a woman’s uterus and is regulated by hormones produced by the ovaries. The uterus can develop polyps, abnormal, benign muscle growth called fibroids or precancerous/cancerous lesions, all of which can often lead to heaving bleeding. A woman's ovaries ideally should produce balanced hormones that control the menstrual bleeding. However, an imbalance in these hormones are one of the more common causes of menorrhagia. Many things can affect the ovaries and alter those hormones. Issues such as emotional stress, obesity, weight fluctuations, certain medical conditions and some medications can influence the ovarian hormones in a negative way and ultimately lead to heavy menstrual bleeding.
Gynecologist can sort through these possible causes and narrow them down to determine which treatment method would be most appropriate to correct the heavy menstrual bleeding. A complete patient history, physical exam, blood work, and, sometimes, an ultrasound are all that is needed to determine the most likely causes for the increased bleeding. From there, your physician will be able to identify the treatment plan that will work best for your personal situation.
Hormones are often the most common treatment for heavy menstrual bleeding. If a patient is able to use them, estrogen/progesterone medications are prescribed and can work well in many cases.
However, if hormone therapy is not indicated for treatment, then there are some very effective and simple surgical procedures to correct the problem. New endometrial ablation devices, such as NovaSure, Genesys HTA, and Minerva, have shown a 95 percent improvement in abnormal bleeding and the ability to cause menses to cease completely. Endometrial ablations are done as an outpatient or same-day procedure and usually only require 15-30 minutes operating time. Additionally, if fibroids are present, those can also be removed and ultimately improve the success of the procedure.
If neither hormones or ablation procedures are successful in controlling the heavy menstrual bleeding, the next option would most likely be a hysterectomy. Like endometrial ablation procedures, most hysterectomies can now be done on an outpatient basis with the use of laparoscopic assistance. This means you can have the procedure and go home the same day with close follow-up in your physician's office post operatively.